Provider Demographics
NPI:1528451986
Name:LEE, THERESA ANN (CAP)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANN
Last Name:LEE
Suffix:
Gender:F
Credentials:CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 SHERWOOD AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3075
Mailing Address - Country:US
Mailing Address - Phone:321-223-0454
Mailing Address - Fax:321-332-0645
Practice Address - Street 1:599 SHERWOOD AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3075
Practice Address - Country:US
Practice Address - Phone:321-223-0454
Practice Address - Fax:321-332-0645
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL007768-2015101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$OtherSOCIAL SECURITY NUMBER