Provider Demographics
NPI:1578924080
Name:WONG, VICKY LEE
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:LEE
Last Name:WONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 KAMAKEE ST
Mailing Address - Street 2:306
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4203
Mailing Address - Country:US
Mailing Address - Phone:808-596-4555
Mailing Address - Fax:
Practice Address - Street 1:401 KAMAKEE ST
Practice Address - Street 2:305
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4203
Practice Address - Country:US
Practice Address - Phone:808-596-4555
Practice Address - Fax:808-596-4555
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health