Provider Demographics
NPI:1972043545
Name:LEE, ANGELA M (ED D, LPC)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:ED D, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5506 GRINNELL ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-1118
Mailing Address - Country:US
Mailing Address - Phone:806-239-3609
Mailing Address - Fax:
Practice Address - Street 1:4116 GRAYSON PL
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-6417
Practice Address - Country:US
Practice Address - Phone:806-239-3609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75256101Y00000X, 101YM0800X, 101YP2500X
GALPC012049101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health