Provider Demographics
NPI:1255541397
Name:LEI, CONNIE POU WAN
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:POU WAN
Last Name:LEI
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 1:30 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-3715
Mailing Address - Country:US
Mailing Address - Phone:415-971-3131
Mailing Address - Fax:
Practice Address - Street 1:310 8TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6526
Practice Address - Country:US
Practice Address - Phone:510-451-6729
Practice Address - Fax:510-268-0202
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor