Provider Demographics
NPI:1548934912
Name:LEE, GLORIA
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 MEDICAL PLAZA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-9759
Mailing Address - Country:US
Mailing Address - Phone:980-999-3405
Mailing Address - Fax:980-999-3550
Practice Address - Street 1:8420 MEDICAL PLAZA DR STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-9759
Practice Address - Country:US
Practice Address - Phone:980-999-3405
Practice Address - Fax:980-999-3550
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC000026296031OtherCOUNSELOR