Provider Demographics
NPI:1396298923
Name:LEE, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LEE
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 1:1301 RIVERPLACE BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-9032
Mailing Address - Country:US
Mailing Address - Phone:904-562-1391
Mailing Address - Fax:904-562-1361
Practice Address - Street 1:1301 RIVERPLACE BLVD STE 800
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9032
Practice Address - Country:US
Practice Address - Phone:904-562-1391
Practice Address - Fax:904-562-1361
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7710101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health