Provider Demographics
NPI:1760359046
Name:LEE, SEONGWON (PSYD, DLLP)
Entity type:Individual
Prefix:DR
First Name:SEONGWON
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PSYD, DLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41400 DEQUINDRE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3751
Mailing Address - Country:US
Mailing Address - Phone:586-580-2975
Mailing Address - Fax:586-580-2954
Practice Address - Street 1:39150 DEQUINDRE RD STE 100
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-6983
Practice Address - Country:US
Practice Address - Phone:586-580-2975
Practice Address - Fax:586-580-2954
Is Sole Proprietor?:No
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6351004868103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist