| Lee Street Services Llc | |
|
1202 East Mountain St, Unit C Kernersville NC 27406 | |
| (336) 655-5370 | |
| Not Available |
| Full Name | Lee Street Services Llc |
|---|---|
| Speciality | Community Based Residential Treatment Facility, Mental Illness |
| Location | 1202 East Mountain St, Unit C, Kernersville, North Carolina |
| Authorized Official Name and Position | Michael Headley (PRESIDENT) |
| Authorized Official Contact | 3366555370 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lee Street Services Llc 1202 E Mountain St Ste C Kernersville NC 27284-7900 Ph: (336) 655-5370 | Lee Street Services Llc 1202 East Mountain St, Unit C Kernersville NC 27406 Ph: (336) 655-5370 |
| NPI Number | 1811433089 |
|---|---|
| Provider Enumeration Date | 01/12/2017 |
| Last Update Date | 01/12/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811433089 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | (* (Not Available)) | Primary |
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