Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 110576 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | CA | |
N | 103TS0200X | School Psychologist | CA |
NPI | 1184296964 |
---|---|
Provider Name | Diedra Lee |
First Address | San Diego, CA 92175-1112 |
Second Address | San Diego, CA 92113-3379 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2021 |
Last Update Date | 12/07/2021 |