Provider Demographics
NPI:1669874459
Name:LEE, RONALD JR (CADC, CAS)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:LEE
Suffix:JR
Gender:M
Credentials:CADC, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-2514
Mailing Address - Country:US
Mailing Address - Phone:171-465-9758
Mailing Address - Fax:
Practice Address - Street 1:13511 SUNNYVALE AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3232
Practice Address - Country:US
Practice Address - Phone:714-659-7586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL0907011902101YA0400X
CAC060580919101YM0800X, 101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional