Healthcare Provider Details

I. General information

NPI: 1114549169
Provider Name (Legal Business Name): GEORGE LEE XIONG MA, LCPC, ADHD-CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 SKOKIE BLVD UNIT 351
NORTHBROOK IL
60062-2344
US

IV. Provider business mailing address

770 SKOKIE BLVD UNIT 351
NORTHBROOK IL
60062-2344
US

V. Phone/Fax

Practice location:
  • Phone: 763-267-1766
  • Fax:
Mailing address:
  • Phone: 763-267-1766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.015887
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.015933
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: