Provider Demographics
NPI:1205294295
Name:LEE-MCHUNGANJI, TEREHASA (LICDC-CS)
Entity type:Individual
Prefix:
First Name:TEREHASA
Middle Name:
Last Name:LEE-MCHUNGANJI
Suffix:
Gender:F
Credentials:LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E MOUND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5571
Mailing Address - Country:US
Mailing Address - Phone:614-227-9694
Mailing Address - Fax:614-227-0370
Practice Address - Street 1:510 E MOUND ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5571
Practice Address - Country:US
Practice Address - Phone:614-227-9694
Practice Address - Fax:614-227-0370
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH933656101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)