Healthcare Provider Details

I. General information

NPI: 1164994661
Provider Name (Legal Business Name): JENEE LEE-STAR STINSON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENEE L IDEN

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 E DAVIS ST
BURLINGTON NC
27215-5922
US

IV. Provider business mailing address

209 7TH ST FL 3
AUGUSTA GA
30901-1486
US

V. Phone/Fax

Practice location:
  • Phone: 336-513-8550
  • Fax: 743-205-3533
Mailing address:
  • Phone: 706-842-5330
  • Fax: 706-842-5340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-69832
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1645
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: