Healthcare Provider Details

I. General information

NPI: 1497575658
Provider Name (Legal Business Name): CARISSA CLAIRE LEE MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 THUNDERSTICK DR STE 1104
LEXINGTON KY
40505-9009
US

IV. Provider business mailing address

2250 THUNDERSTICK DR STE 1104
LEXINGTON KY
40505-9009
US

V. Phone/Fax

Practice location:
  • Phone: 859-254-1035
  • Fax: 859-254-2075
Mailing address:
  • Phone: 859-254-1035
  • Fax: 859-254-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCSW00001259
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001259
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: