Provider Demographics
NPI:1346455607
Name:LEE, SALLY
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2907 LOOMIS ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1628
Mailing Address - Country:US
Mailing Address - Phone:808-945-3690
Mailing Address - Fax:808-945-2811
Practice Address - Street 1:2907 LOOMIS ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1628
Practice Address - Country:US
Practice Address - Phone:808-945-3690
Practice Address - Fax:808-945-2811
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI480101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor