Doctor Name: | MS. RENATA MICHELLE LEE |
NPI Number: | 1124335658 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 34003010A |
Business Practice Address: | 650 Joel Dr Fort Campbell, KY - 422235318 |
Business Phone Number: | 2707988400 |
Business Fax Number: | |
Mailing Address: | 650 Joel Dr, FORT CAMPBELL |
State: | KY |
Postal Code: | 422235318 |
Phone Number: | 2707988400 |
Fax Number: | |
NPI Enumeration Date: | 09/03/2010 |
NPI Last Update Date: | 09/03/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 34003010A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |