Provider Demographics
NPI:1386973410
Name:HORTON, LEE
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:HORTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 NASH ST W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3045
Mailing Address - Country:US
Mailing Address - Phone:252-291-2200
Mailing Address - Fax:252-297-2296
Practice Address - Street 1:608 NASH ST W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3045
Practice Address - Country:US
Practice Address - Phone:252-291-2200
Practice Address - Fax:252-297-2296
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112126Medicaid