Provider Demographics
NPI:1497575658
Name:LEE, CARISSA CLAIRE (MSW, CSW)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:CLAIRE
Last Name:LEE
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 MAYAPPLE LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8922
Mailing Address - Country:US
Mailing Address - Phone:270-307-7502
Mailing Address - Fax:
Practice Address - Street 1:198 MAYAPPLE LN
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8922
Practice Address - Country:US
Practice Address - Phone:270-307-7502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY258035101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)