Healthcare Provider Details

I. General information

NPI: 1073812285
Provider Name (Legal Business Name): LEE LLOYD LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 RANDALL PARKWAY
WILMINGTON NC
28403-2829
US

IV. Provider business mailing address

5010 RANDALL PARKWAY
WILMINGTON NC
28403-2829
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-5719
  • Fax: 910-799-8180
Mailing address:
  • Phone: 910-791-5719
  • Fax: 910-799-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC000450
License Number StateNC

VIII. Authorized Official

Name: LEE B LLOYD
Title or Position: OWNER
Credential: LCSW
Phone: 910-791-5719