Provider Demographics
NPI:1285416412
Name:LEE, CAVERS (MSW, LCSWA)
Entity type:Individual
Prefix:MRS
First Name:CAVERS
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:MRS
Other - First Name:KAYE
Other - Middle Name:LEE
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSWA
Mailing Address - Street 1:6006 FARM POND RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5783
Mailing Address - Country:US
Mailing Address - Phone:704-236-9595
Mailing Address - Fax:
Practice Address - Street 1:6006 FARM POND RD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5783
Practice Address - Country:US
Practice Address - Phone:704-236-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP019871104100000X, 1041C0700X
NC12862361041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool