Provider Information for 1609968932
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GRACE MIMI LEE LCSW
Sex: Female
NPI: 1609968932
Last Updated: 2014-04-01
Certification Date:
Certification Date:
Details
Name | Value | ||||||||||||||||
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NPI | 1609968932 | ||||||||||||||||
Enumeration Date | 2006-09-28 | ||||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||||
Sole Proprietor | NO | ||||||||||||||||
Status | Active | ||||||||||||||||
Mailing Address | 405 W 5TH ST SUITE #212 SANTA ANA, CA 92701-4599 United States Phone: 714-834-2125 | Fax: | ||||||||||||||||
Primary Practice Address | 405 W 5TH ST SUITE #212 SANTA ANA, CA 92701-4599 United States Phone: 714-834-2125 | Fax: | ||||||||||||||||
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