Provider Demographics
NPI:1073227682
Name:LEE, RANDA
Entity Type:Individual
Prefix:
First Name:RANDA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 S. VINE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGLES
Mailing Address - State:WA
Mailing Address - Zip Code:98362
Mailing Address - Country:US
Mailing Address - Phone:360-452-2443
Mailing Address - Fax:360-452-2738
Practice Address - Street 1:806 S. VINE ST
Practice Address - Street 2:
Practice Address - City:PORT ANGLES
Practice Address - State:WA
Practice Address - Zip Code:98362
Practice Address - Country:US
Practice Address - Phone:360-452-2443
Practice Address - Fax:360-452-2738
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)