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General NPI Number Information
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NPI Number | 1801033980
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Entity Type | Individual
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Provider Name | LUCILLE LEE MCMICHAEL LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 11/11/2015
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Provider Practice Location Address
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Address Line | 1830 DESTINY LN 112
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City | BOWLING GREEN
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State | KY
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Zip | 42104-1089
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Country | US
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Telephone | 270-746-9995
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Fax | 270-393-9001
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Provider Business Mailing Address
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Address Line | 1830 DESTINY LN SUITE 112
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City | BOWLING GREEN
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State | KY
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Zip | 42104-1087
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Country | US
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Telephone | 270-779-7312
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Fax | 270-393-9011
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3277
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License Number State | KY
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