Healthcare Provider Details

I. General information

NPI: 1376830547
Provider Name (Legal Business Name): TALISHA HELEN LEE PHD, LCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 EXECUTIVE BLVD SUITE 1030
NORTH BETHESDA MD
20852-3809
US

IV. Provider business mailing address

6010 EXECUTIVE BLVD SUITE 1030
NORTH BETHESDA MD
20852-3809
US

V. Phone/Fax

Practice location:
  • Phone: 240-428-4413
  • Fax: 301-587-6279
Mailing address:
  • Phone: 240-428-4413
  • Fax: 301-587-6279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number05014
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0810004440
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: