Provider Demographics
NPI:1376154211
Name:VYAS, DESIREE LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:LEE
Last Name:VYAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44164 BRISTOW CIR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3306
Mailing Address - Country:US
Mailing Address - Phone:571-455-0566
Mailing Address - Fax:
Practice Address - Street 1:21155 WHITFIELD PL STE 202
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-7277
Practice Address - Country:US
Practice Address - Phone:571-375-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty