Provider Demographics
NPI:1427232974
Name:FONG, LINA YS (LCSW, ACSW)
Entity Type:Individual
Prefix:DR
First Name:LINA
Middle Name:YS
Last Name:FONG
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:MRS
Other - First Name:LINA
Other - Middle Name:YS
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, LCSW, ACSW
Mailing Address - Street 1:3620 CREEL CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-2004
Mailing Address - Country:US
Mailing Address - Phone:859-245-5152
Mailing Address - Fax:859-245-5152
Practice Address - Street 1:3620B CREEL CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517
Practice Address - Country:US
Practice Address - Phone:859-245-5152
Practice Address - Fax:859-245-5152
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY17641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical