Provider Demographics
NPI:1134731490
Name:LEE, GE
Entity type:Individual
Prefix:
First Name:GE
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1252 ROBINHOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-4061
Mailing Address - Country:US
Mailing Address - Phone:794-488-6755
Mailing Address - Fax:888-734-8599
Practice Address - Street 1:420 FAIRLEY ST STE B
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3612
Practice Address - Country:US
Practice Address - Phone:910-610-9151
Practice Address - Fax:888-734-8599
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A15586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health