Provider Demographics
NPI:1780152439
Name:LEE, LANDON BARRETT (EDD)
Entity type:Individual
Prefix:DR
First Name:LANDON
Middle Name:BARRETT
Last Name:LEE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2143 SABLESHIRE WAY SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6476
Mailing Address - Country:US
Mailing Address - Phone:770-842-2435
Mailing Address - Fax:
Practice Address - Street 1:2727 BOULDERCREST RD SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-4811
Practice Address - Country:US
Practice Address - Phone:770-842-2435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-10
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009071101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional