Provider Demographics
NPI:1770606501
Name:PUTNAM, LEA HARRELL (MED)
Entity type:Individual
Prefix:MRS
First Name:LEA
Middle Name:HARRELL
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MISS
Other - First Name:LEA
Other - Middle Name:MICHELLE
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:48 AMERSHAM LN
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-9244
Mailing Address - Country:US
Mailing Address - Phone:828-280-1305
Mailing Address - Fax:
Practice Address - Street 1:50 REDDICK RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2717
Practice Address - Country:US
Practice Address - Phone:828-298-0186
Practice Address - Fax:828-298-4870
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4664101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional