Provider Demographics
NPI:1750409611
Name:LEE, MICHELE (MS)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SHELLIE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:1190 FIELD ST
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31022-2123
Mailing Address - Country:US
Mailing Address - Phone:478-676-3456
Mailing Address - Fax:
Practice Address - Street 1:1190 FIELD ST
Practice Address - Street 2:
Practice Address - City:DUDLEY
Practice Address - State:GA
Practice Address - Zip Code:31022-2123
Practice Address - Country:US
Practice Address - Phone:478-676-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health