Provider Demographics
NPI:1487120929
Name:LEE, EDNISHA
Entity type:Individual
Prefix:
First Name:EDNISHA
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 1:7600 ANNE MARIE CT
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-1574
Mailing Address - Country:US
Mailing Address - Phone:504-230-9918
Mailing Address - Fax:
Practice Address - Street 1:2221 PHILIP ST STE 209
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-2525
Practice Address - Country:US
Practice Address - Phone:504-826-2675
Practice Address - Fax:504-826-2672
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician