Provider Demographics
NPI:1104385418
Name:LI, LA (LICSW)
Entity Type:Individual
Prefix:
First Name:LA
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11752 163RD PL NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-2395
Mailing Address - Country:US
Mailing Address - Phone:919-348-3237
Mailing Address - Fax:
Practice Address - Street 1:11752 163RD PL NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-2395
Practice Address - Country:US
Practice Address - Phone:919-348-3237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-16
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC608001371041C0700X
WALW611521081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical