Individual
LENA LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 863-1132
(228) 865-1700
Mailing address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 863-1132
(228) 865-1700
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
M5558
MS
101YM0800X
Mental Health Counselor
M5558
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018213
—
MS
Enumeration date
12/14/2015
Last updated
12/14/2015
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