Healthcare Provider Details

I. General information

NPI: 1700530029
Provider Name (Legal Business Name): MICHELLE LEE LCSWC INDIVIDUAL AND COUPLES COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2022
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 CANTERBURY RD APT 612
BALTIMORE MD
21218-2363
US

IV. Provider business mailing address

2 FAR CORNERS CT
SPARKS GLENCOE MD
21152-9200
US

V. Phone/Fax

Practice location:
  • Phone: 443-320-3162
  • Fax:
Mailing address:
  • Phone: 443-320-3162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE LEE
Title or Position: THERAPIST
Credential: LCSW-C
Phone: 443-203-9659