Provider Demographics
NPI:1235902453
Name:VAN LEE, FELESIA ANN (MSW)
Entity type:Individual
Prefix:
First Name:FELESIA
Middle Name:ANN
Last Name:VAN LEE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 SANDY PLAINS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4288
Mailing Address - Country:US
Mailing Address - Phone:770-218-8670
Mailing Address - Fax:770-212-2339
Practice Address - Street 1:2627 SANDY PLAINS RD STE 102
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4288
Practice Address - Country:US
Practice Address - Phone:770-218-8670
Practice Address - Fax:770-212-2339
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator