Basic Information
Provider Information
NPI: 1003002924
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEE
FirstName: NANCY
MiddleName: CAROL
NamePrefix: MISS
NameSuffix:  
Credential: LCSW-P, CMSW, MHA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 508 FULTON ST
Address2: SOCIAL WORK SERVICE (122)
City: DURHAM
State: NC
PostalCode: 277053875
CountryCode: US
TelephoneNumber: 9192860411
FaxNumber: 9194165834
Practice Location
Address1: 508 FULTON ST
Address2: SOCIAL WORK SERVICE (122)
City: DURHAM
State: NC
PostalCode: 277053875
CountryCode: US
TelephoneNumber: 9192860411
FaxNumber: 9194165834
Other Information
ProviderEnumerationDate: 09/25/2007
LastUpdateDate: 09/25/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X7216TNY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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