Healthcare Provider Details

I. General information

NPI: 1144155649
Provider Name (Legal Business Name): MRS. NIA AYANNA WATSON LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 N CAPITOL ST NW
WASHINGTON DC
20011-8400
US

IV. Provider business mailing address

6710 PEPPER ST
CAPITOL HEIGHTS MD
20743-2654
US

V. Phone/Fax

Practice location:
  • Phone: 202-509-3489
  • Fax:
Mailing address:
  • Phone: 202-509-3489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG200004318
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: