Provider Demographics
NPI:1184819963
Name:BRUCE, MICHELLE ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:BRUCE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:ELIZABETH
Other - Last Name:WICKHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:102 HERITAGE WAY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4544
Mailing Address - Country:US
Mailing Address - Phone:571-258-3900
Mailing Address - Fax:703-777-0170
Practice Address - Street 1:102 HERITAGE WAY
Practice Address - Street 2:SUITE 302
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4544
Practice Address - Country:US
Practice Address - Phone:571-258-3900
Practice Address - Fax:703-777-0170
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist