Provider Demographics
NPI:1093135303
Name:LEE, VICKY (LAC)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 N. HAMILTON ST. STE E
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-4113
Mailing Address - Country:US
Mailing Address - Phone:804-200-4054
Mailing Address - Fax:619-795-4423
Practice Address - Street 1:1906 N HAMILTON ST. STE E
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-4113
Practice Address - Country:US
Practice Address - Phone:804-200-4054
Practice Address - Fax:619-795-4423
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15924171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15924OtherCALIFORNIA ACUPUNCTURE BOARD