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General NPI Number Information
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NPI Number | 1962905661
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Entity Type | Individual
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Provider Name | MICHELLE JUNG AH LEE LICSW, SUDP
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Gender | Female
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Dates
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Enumeration Date | 03/09/2018
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Last Update Date | 01/11/2025
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Provider Practice Location Address
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Address Line | 12550 120TH AVE NE UNIT 668
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City | KIRKLAND
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State | WA
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Zip | 98034-7559
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Country | US
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Telephone | 425-747-7892
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Fax |
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Provider Business Mailing Address
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Address Line | 19726 50TH AVE W APT 102
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City | LYNNWOOD
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State | WA
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Zip | 98036-6473
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC61309243
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW61601450
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License Number State | WA
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