Healthcare Provider Details

I. General information

NPI: 1073257341
Provider Name (Legal Business Name): DAMITA LEE MSW, LMHP-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2022
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 MOBJACK PL
NEWPORT NEWS VA
23606-1957
US

IV. Provider business mailing address

201 RIVERSIDE DR
YORKTOWN VA
23692-3411
US

V. Phone/Fax

Practice location:
  • Phone: 757-933-0361
  • Fax:
Mailing address:
  • Phone: 804-919-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0906009753
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: