Provider Demographics
NPI:1891530085
Name:LEE, LAURA NICHOLE (MS)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:NICHOLE
Last Name:LEE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SAINT ANDREWS CT
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-6777
Mailing Address - Country:US
Mailing Address - Phone:912-574-5858
Mailing Address - Fax:912-574-5860
Practice Address - Street 1:14 SAINT ANDREWS CT
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-6777
Practice Address - Country:US
Practice Address - Phone:912-574-5858
Practice Address - Fax:912-574-5860
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health