Provider Demographics
NPI:1538949722
Name:LEMIRE, JUSTINE LEE (MA)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:LEE
Last Name:LEMIRE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 PARKAIRE LN APT 816
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-0102
Mailing Address - Country:US
Mailing Address - Phone:210-896-0630
Mailing Address - Fax:
Practice Address - Street 1:508 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5110
Practice Address - Country:US
Practice Address - Phone:980-389-0619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19087101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health