Healthcare Provider Details

I. General information

NPI: 1013661313
Provider Name (Legal Business Name): MICHELLE LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 WASHINGTONIAN BLVD STE 550
GAITHERSBURG MD
20878-5789
US

IV. Provider business mailing address

9711 WASHINGTONIAN BLVD STE 550
GAITHERSBURG MD
20878-5789
US

V. Phone/Fax

Practice location:
  • Phone: 443-203-9659
  • Fax:
Mailing address:
  • Phone: 443-203-9659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: