Provider Demographics
NPI:1245621796
Name:LEE, ANTOINETTE GAIL (MED, LPCA)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:GAIL
Last Name:LEE
Suffix:
Gender:F
Credentials:MED, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 ANNISTON DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-2230
Mailing Address - Country:US
Mailing Address - Phone:859-699-1083
Mailing Address - Fax:
Practice Address - Street 1:575 ANNISTON DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-2230
Practice Address - Country:US
Practice Address - Phone:859-699-1083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCCCA00216566101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional