Provider Demographics
NPI:1700496122
Name:LEE, EDITH SOYEON (MA)
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:SOYEON
Last Name:LEE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 MCLEAN PROVINCE CIR
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-1668
Mailing Address - Country:US
Mailing Address - Phone:703-531-7639
Mailing Address - Fax:
Practice Address - Street 1:3915 OLD LEE HWY STE 23A
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2432
Practice Address - Country:US
Practice Address - Phone:703-259-5617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-01
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health