Provider Demographics
NPI:1700685229
Name:LE, PHIKHANH THI (LCSW)
Entity type:Individual
Prefix:
First Name:PHIKHANH
Middle Name:THI
Last Name:LE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-1030
Mailing Address - Country:US
Mailing Address - Phone:831-272-2411
Mailing Address - Fax:
Practice Address - Street 1:3110 LAKE DR APT 3
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-2855
Practice Address - Country:US
Practice Address - Phone:831-272-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1267581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical