Provider Demographics
NPI:1720736671
Name:LEE, CAROLE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 CRAFTSMAN CIR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-1530
Mailing Address - Country:US
Mailing Address - Phone:757-698-9713
Mailing Address - Fax:
Practice Address - Street 1:707 GITTINGS ST STE 120
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-6101
Practice Address - Country:US
Practice Address - Phone:757-514-3248
Practice Address - Fax:757-809-5387
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011281101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional