Basic Information
| Provider Information | |||||||||
| NPI: | 1972936656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS,LPC,LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1538 LOUISIANA AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701153553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048962345 | ||||||||
| FaxNumber: | 5048962240 | ||||||||
| Practice Location | |||||||||
| Address1: | 1538 LOUISIANA AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701153553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048962345 | ||||||||
| FaxNumber: | 5048962240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2013 | ||||||||
| LastUpdateDate: | 09/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 1307 | LA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 3991 | LA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.