Individual
PHONG LY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3639 MARTIN LUTHER KING JR WAY S, SEATTLE, WA 98144-6847
(206) 774-2443
(206) 695-7606
Mailing address
3639 MARTIN LUTHER KING JR WAY S, SEATTLE, WA 98144-6847
(206) 774-2443
(206) 695-7606
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2111587
—
WA
Enumeration date
02/06/2014
Last updated
01/08/2020
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