Provider Demographics
NPI:1710110424
Name:WONG-HOLLAND, LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:WONG-HOLLAND
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019B EDWARDS FERRY RD NE # 1042
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3347
Mailing Address - Country:US
Mailing Address - Phone:703-662-3095
Mailing Address - Fax:
Practice Address - Street 1:20576 BLUE WATER CT
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7920
Practice Address - Country:US
Practice Address - Phone:703-608-3629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004944103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical