Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0701009580 | VA |
NPI | 1003426800 |
---|---|
Provider Name | Bethany Grace Lee |
First Address | Roanoke, VA 24018-0605 |
Second Address | Salem, VA 24153-4325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2020 |
Last Update Date | 06/08/2020 |