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NPI Code Detail

MEDICARE: MRS. LAURA NICHOLE LEE MS

MEDICARE: MRS. LAURA NICHOLE LEE MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1891530085
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA NICHOLE LEE MS
Provider Business Mailing Address
First Line : 14 SAINT ANDREWS CT
Second Line :
City : BRUNSWICK
State : GA
Zip : 31520-6777
Country : US
Telephone Number : 912-574-5858
Fax Number : 912-574-5860
Provider Business Practice Location Address
First Line : 14 SAINT ANDREWS CT
Second Line :
City : BRUNSWICK
State : GA
Zip : 31520-6777
Country : US
Telephone Number : 912-574-5858
Fax Number : 912-574-5860
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2024
Last Update Date : 06/28/2024

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