Healthcare Provider Details

I. General information

NPI: 1598835472
Provider Name (Legal Business Name): STANLEY V LEE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5621 RADFORD LOOP
FAIRBURN GA
30213-5517
US

IV. Provider business mailing address

DEPARMENT OF VETERANS AFFAIRS 10000 BRECKSVILLE RD
BRECKSVILLE OH
44141
US

V. Phone/Fax

Practice location:
  • Phone: 330-903-0811
  • Fax:
Mailing address:
  • Phone: 330-724-1247
  • Fax: 330-724-1029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004560
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: