Provider Information for 1063564516
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JOHN LEE LICSW
Sex: Male
NPI: 1063564516
Last Updated: 2012-04-28
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||
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| NPI | 1063564516 | ||||||||||||||||
| Enumeration Date | 2007-01-17 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 3085 BROAD ST SUITE I CHATTANOOGA, TN 37408-3084 United States Phone: 423-248-2482 | Fax:888-420-3050 | ||||||||||||||||
| Primary Practice Address | 3085 BROAD ST SUITE I CHATTANOOGA, TN 37408-3084 United States Phone: 423-248-2482 | Fax:888-420-3050 | ||||||||||||||||
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