Provider Demographics
NPI:1699119461
Name:LEE, JAMES A (LMSW, CADC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:LEE
Suffix:
Gender:M
Credentials:LMSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C/O RELIANCE COUNSELING, LLC
Mailing Address - Street 2:11126 WAYNE RD.
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174
Mailing Address - Country:US
Mailing Address - Phone:734-377-8720
Mailing Address - Fax:734-527-6183
Practice Address - Street 1:C/O RELIANCE COUNSELING, LLC
Practice Address - Street 2:11126 WAYNE RD.
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174
Practice Address - Country:US
Practice Address - Phone:734-377-8720
Practice Address - Fax:734-527-6183
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-01347101YA0400X
MI68011050791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)