Provider Demographics
NPI:1720087190
Name:LEE, CHARLOTTE ANN (CARTER) (LDCC, LADAC)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:ANN (CARTER)
Last Name:LEE
Suffix:
Gender:F
Credentials:LDCC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 OPPENHEIMER DR
Mailing Address - Street 2:SUITE 297
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2384
Mailing Address - Country:US
Mailing Address - Phone:505-662-9736
Mailing Address - Fax:505-661-8088
Practice Address - Street 1:555 OPPENHEIMER DR
Practice Address - Street 2:SUITE 207
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2384
Practice Address - Country:US
Practice Address - Phone:505-662-9736
Practice Address - Fax:505-661-8088
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0064791101Y00000X
NM005706101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)