Provider Demographics
NPI:1134559255
Name:LEE, KATHLEEN ANNE (LPC, LCADC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNE
Last Name:LEE
Suffix:
Gender:F
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANNE
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:411 KAILA CT
Mailing Address - Street 2:
Mailing Address - City:SHAMONG
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-9688
Mailing Address - Country:US
Mailing Address - Phone:609-401-2012
Mailing Address - Fax:609-232-7271
Practice Address - Street 1:411 KAILA CT
Practice Address - Street 2:
Practice Address - City:SHAMONG
Practice Address - State:NJ
Practice Address - Zip Code:08088-9688
Practice Address - Country:US
Practice Address - Phone:609-401-2012
Practice Address - Fax:609-232-7271
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00207100101YA0400X
NJ37PC00440600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA144400OtherDOH- MH
NJ896321004OtherDMHAS- MH
NJ2000480OtherDMHAS- SUD
PA097115OtherDDAP
NJ2000345OtherDHS LICENSE- AMBULATORY CARE CONSISTING OF ADDICTION SERVICES & OTP
NJ96503-01-04OtherN.J. DEPT. HUMAN SERVICES
NJ0102903OtherNJ MEDICAID PROVIDER ID: INDEPENDENT CLINIC- NARCOTIC & DRUG ABUSE
NJ2000078OtherDHS LICENSE- AMBULATORY CARE CONSISTING OF ADDICTION SERVICES
NJ215114000OtherMAGELLAN MIS
NJNJ-10046-MOtherSUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
NJ0372331Medicaid