Provider Demographics
NPI:1437233624
Name:WILLIAMS, LEE MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:MICHAEL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17511 CAMINITO CANASTO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1162
Mailing Address - Country:US
Mailing Address - Phone:858-451-8385
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF VETERAN AFFAIRS, 3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:PSYCHOLOGY DEPARTMENT
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161
Practice Address - Country:US
Practice Address - Phone:619-260-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 34127106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist