MEDICARE: Q'NEISHIA DANIELLE LEE LPC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	A10416	NC

General Provider Information

NPI Number	:	1144657776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	Q'NEISHIA DANIELLE LEE LPC-A

Provider Business Mailing Address
First Line	:	5836 KENVILLE GREEN CIR
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-7129
Country	:	US
Telephone Number	:	919-922-0713
Fax Number	:

Provider Business Practice Location Address
First Line	:	5836 KENVILLE GREEN CIR
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-7129
Country	:	US
Telephone Number	:	919-922-0713
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2013
Last Update Date	:	09/27/2013

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