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General NPI Number Information
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NPI Number | 1043961436
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Entity Type | Individual
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Provider Name | BERNICE L LEE LPC-R
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Gender | Female
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Dates
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Enumeration Date | 01/17/2022
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Last Update Date | 01/17/2022
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Provider Practice Location Address
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Address Line | 100 BRUNSWICK AVE # A
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City | EMPORIA
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State | VA
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Zip | 23847-2010
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Country | US
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Telephone | 434-336-1103
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Fax | 434-336-1105
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Provider Business Mailing Address
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Address Line | PO BOX 1364
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City | ROANOKE RAPIDS
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State | NC
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Zip | 27870-1364
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Country | US
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Telephone | 252-287-7870
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0704007276
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License Number State | VA
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