Healthcare Provider Details

I. General information

NPI: 1164715140
Provider Name (Legal Business Name): MELISSA LEE COVER LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 COMMERCE BLVD CAPITOL CARE SOUTH
IRONDALE AL
35210-1211
US

IV. Provider business mailing address

2619 COMMERCE BLVD CAPITOL CARE SOUTH
IRONDALE AL
35210-1211
US

V. Phone/Fax

Practice location:
  • Phone: 205-956-2000
  • Fax: 205-876-1016
Mailing address:
  • Phone: 205-956-2000
  • Fax: 205-876-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2170
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: