Healthcare Provider Details

I. General information

NPI: 1851791370
Provider Name (Legal Business Name): EMILY LEE MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY NOAH

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 N SPRING ST
GREENSBORO NC
27401
US

IV. Provider business mailing address

231 N SPRING ST
GREENSBORO NC
27401-2231
US

V. Phone/Fax

Practice location:
  • Phone: 336-899-8800
  • Fax:
Mailing address:
  • Phone: 336-899-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14683
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0013434
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: