Provider Demographics
NPI:1376830547
Name:LEE, TALISHA HELEN (PHD, LCP)
Entity Type:Individual
Prefix:DR
First Name:TALISHA
Middle Name:HELEN
Last Name:LEE
Suffix:
Gender:F
Credentials:PHD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 EXECUTIVE BLVD
Mailing Address - Street 2:SUITE 1030
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3809
Mailing Address - Country:US
Mailing Address - Phone:240-428-4413
Mailing Address - Fax:301-587-6279
Practice Address - Street 1:6010 EXECUTIVE BLVD
Practice Address - Street 2:SUITE 1030
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3809
Practice Address - Country:US
Practice Address - Phone:240-428-4413
Practice Address - Fax:301-587-6279
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05014103TC2200X
VA0810004440103TC2200X
DC103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool