Provider Demographics
NPI:1831884949
Name:LEE, PRINCESS COLLEEN (MED, LPC)
Entity type:Individual
Prefix:
First Name:PRINCESS
Middle Name:COLLEEN
Last Name:LEE
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6943 SILVER GRASS CT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-3597
Mailing Address - Country:US
Mailing Address - Phone:770-856-6345
Mailing Address - Fax:
Practice Address - Street 1:6943 SILVER GRASS CT
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-3597
Practice Address - Country:US
Practice Address - Phone:770-856-6345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA220821101YS0200X
GALPCC013470101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool