Provider Demographics
NPI:1669273314
Name:LEE, TOMI (QMHP, MBA, MED)
Entity type:Individual
Prefix:
First Name:TOMI
Middle Name:
Last Name:LEE
Suffix:
Gender:
Credentials:QMHP, MBA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SEMINOLE TRL
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-1871
Mailing Address - Country:US
Mailing Address - Phone:434-429-8543
Mailing Address - Fax:434-228-7003
Practice Address - Street 1:208 SEMINOLE TRL
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-1871
Practice Address - Country:US
Practice Address - Phone:434-429-8543
Practice Address - Fax:434-228-7003
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0732010644171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator