Provider Demographics
NPI:1831407824
Name:RIDENS, LEE SAECKER (PHD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:SAECKER
Last Name:RIDENS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13101 GLENMEADOW CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3014
Mailing Address - Country:US
Mailing Address - Phone:804-794-8900
Mailing Address - Fax:804-378-2012
Practice Address - Street 1:13821 VILLAGE MILL DR STE B
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4314
Practice Address - Country:US
Practice Address - Phone:804-794-8900
Practice Address - Fax:804-378-2012
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005404103TC0700X
103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool