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General NPI Number Information
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NPI Number | 1720736671
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Entity Type | Individual
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Provider Name | CAROLE LEE MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 707 GITTINGS ST STE 120
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City | SUFFOLK
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State | VA
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Zip | 23434-6101
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Country | US
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Telephone | 757-514-3248
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Fax | 757-809-5387
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Provider Business Mailing Address
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Address Line | 268 CRAFTSMAN CIR
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City | SUFFOLK
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State | VA
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Zip | 23434-1530
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Country | US
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Telephone | 757-698-9713
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701011281
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License Number State | VA
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