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General NPI Number Information
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NPI Number | 1144304551
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Entity Type | Individual
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Provider Name | TERRY LEE-WILK PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 10 N GREENE ST
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City | BALTIMORE
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State | MD
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Zip | 21201-1524
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Country | US
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Telephone | 410-605-7413
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Fax |
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Provider Business Mailing Address
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Address Line | 8604 SASSAFRAS CT
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City | COLUMBIA
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State | MD
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Zip | 21046-1095
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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