Provider Demographics
NPI:1053361931
Name:WORTHINGTON, LEE HALL (MED,LPC,ACS)
Entity type:Individual
Prefix:MS
First Name:LEE
Middle Name:HALL
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:MED,LPC,ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:5628 OLD CHEROKEE LANE
Mailing Address - City:SAXAPAHAW
Mailing Address - State:NC
Mailing Address - Zip Code:27340-0193
Mailing Address - Country:US
Mailing Address - Phone:336-376-9986
Mailing Address - Fax:
Practice Address - Street 1:5628 OLD CHEROKEE LN
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253
Practice Address - Country:US
Practice Address - Phone:336-376-9986
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health