Organization
LEE STREET SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL HEADLEY (PRESIDENT)
(336) 655-5370
Entity
Organization
Contact information
Practice address
1202 EAST MOUNTAIN ST, UNIT C, KERNERSVILLE, NC 27406
(336) 655-5370
Mailing address
1202 E MOUNTAIN ST STE C, KERNERSVILLE, NC 27284-7900
(336) 655-5370
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/12/2017
Last updated
01/12/2017
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