Basic Information
| Provider Information | |||||||||
| NPI: | 1750848651 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | BRITTANY | ||||||||
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| Credential: | LGPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1074 BIGGS HWY | ||||||||
| Address2: | |||||||||
| City: | RISING SUN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219112228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434660963 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2057 PULASKI HWY | ||||||||
| Address2: | |||||||||
| City: | NORTH EAST | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219013744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438774044 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2019 | ||||||||
| LastUpdateDate: | 02/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 39308 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.