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General NPI Number Information
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NPI Number | 1174357479
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Entity Type | Individual
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Provider Name | MRS. CHRISTIE ANN LEE
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Gender | Female
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Dates
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Enumeration Date | 08/28/2024
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 170 MEETING ST
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City | CHARLESTON
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State | SC
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Zip | 29401-3153
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Country | US
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Telephone | 843-983-8320
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Fax |
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Provider Business Mailing Address
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Address Line | 189 MIMS RD
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City | HARLEYVILLE
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State | SC
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Zip | 29448-3339
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Country | US
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Telephone | 843-642-1916
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB1180377
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License Number State | SC
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