Provider Demographics
NPI:1326793084
Name:LEE, ALFRED J (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:J
Last Name:LEE
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2052 LAKE AVE STE F
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2460
Mailing Address - Country:US
Mailing Address - Phone:626-398-3897
Mailing Address - Fax:
Practice Address - Street 1:2052 LAKE AVE STE F
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-2460
Practice Address - Country:US
Practice Address - Phone:626-398-3897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1458400222101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)