Provider Demographics
NPI:1336628015
Name:LEE, DAQUALA S (LISW)
Entity Type:Individual
Prefix:
First Name:DAQUALA
Middle Name:S
Last Name:LEE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 SHAKER BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-3871
Mailing Address - Country:US
Mailing Address - Phone:216-417-8813
Mailing Address - Fax:
Practice Address - Street 1:11201 SHAKER BLVD STE 308
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3871
Practice Address - Country:US
Practice Address - Phone:216-417-8813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.23047011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical