Provider Demographics
NPI:1033839923
Name:VAN VOORHIS, LYDIA MARIE (MED, EDS)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:MARIE
Last Name:VAN VOORHIS
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N CAROLINA AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2004
Mailing Address - Country:US
Mailing Address - Phone:202-698-3363
Mailing Address - Fax:
Practice Address - Street 1:301 N CAROLINA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2004
Practice Address - Country:US
Practice Address - Phone:202-698-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool