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General NPI Number Information
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NPI Number | 1982360079
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Entity Type | Organization
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Legal Business Name | ROBERT T LEE FOUNDATION LLC
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Dates
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Enumeration Date | 11/12/2021
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Last Update Date | 04/09/2022
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Provider Practice Location Address
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Address Line | 610 THIMBLE SHOALS BLVD # 403
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2573
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Country | US
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Telephone | 901-672-2228
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Fax |
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Provider Business Mailing Address
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Address Line | 31 HARWOOD AVE
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City | HAMPTON
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State | VA
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Zip | 23664-1044
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Country | US
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Telephone | 901-672-2228
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JARVIS DONNELL LEE
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Credential | LCSW
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Telephone | 901-672-2228
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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 |
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License Number State |
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