Provider Demographics
NPI:1942612635
Name:TALISHA LEE, PH.D., LLC
Entity Type:Organization
Organization Name:TALISHA LEE, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TALISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCP
Authorized Official - Phone:240-428-4413
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05014103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty