Provider Demographics
NPI:1538266671
Name:LEE, MIREONG (LPC, LSATP, CSAC)
Entity type:Individual
Prefix:
First Name:MIREONG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LPC, LSATP, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W BROAD ST STE 305
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3220
Mailing Address - Country:US
Mailing Address - Phone:703-533-3302
Mailing Address - Fax:703-237-2083
Practice Address - Street 1:701 W BROAD ST STE 305
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3220
Practice Address - Country:US
Practice Address - Phone:703-533-3302
Practice Address - Fax:703-237-2083
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710101496101YA0400X
VA0701002805101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10414712OtherCAQH
VA7950362OtherAETNA
VA292774OtherAMERIGROUP
VA89130011OtherCAREFIRST BCBS
VA266613OtherMAMSI
VA288328OtherANTHEM
VA116161OtherUNITED BEHAVIORAL HEALTH