Provider Demographics
NPI:1801172176
Name:LEE, RACHEL MARCIA
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARCIA
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 DANZID DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-9281
Mailing Address - Country:US
Mailing Address - Phone:843-871-9341
Mailing Address - Fax:
Practice Address - Street 1:7671 NORTHWOODS BLVD
Practice Address - Street 2:STE L
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4058
Practice Address - Country:US
Practice Address - Phone:843-324-2956
Practice Address - Fax:843-871-9341
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6077174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist