MEDICARE: LANITRA WILSON LEE MS, LPC

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
1	101YM0800X	Mental Health Counselor	LPC04646	AL
2	101Y00000X	Counselor	04646	AL

General Provider Information

NPI Number	:	1982231965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANITRA WILSON LEE MS, LPC

Provider Business Mailing Address
First Line	:	4371 NARROW LANE RD STE 201
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-2975
Country	:	US
Telephone Number	:	334-245-9743
Fax Number	:

Provider Business Practice Location Address
First Line	:	4385 NARROW LANE RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-2978
Country	:	US
Telephone Number	:	334-747-7754
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2020
Last Update Date	:	11/01/2024

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