Healthcare Provider Details

I. General information

NPI: 1619714300
Provider Name (Legal Business Name): JINNY LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 N PARK AVE
CHEVY CHASE MD
20815-4518
US

IV. Provider business mailing address

205 ROBINSON ST APT 4
PITTSBURGH PA
15213-2332
US

V. Phone/Fax

Practice location:
  • Phone: 202-244-0818
  • Fax:
Mailing address:
  • Phone: 267-401-9762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: