Doctor Name: | DR. MICHAEL K LEA |
NPI Number: | 1215932678 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD, PSYD |
License Number: | LC0974 |
Business Practice Address: | 6045 Solomons Island Rd Huntingtown, MD - 206398876 |
Business Phone Number: | 4102575200 |
Business Fax Number: | 4102572442 |
Mailing Address: | 6045 Solomons Island Rd, HUNTINGTOWN |
State: | MD |
Postal Code: | 206398876 |
Phone Number: | 4102575200 |
Fax Number: | 4102572442 |
NPI Enumeration Date: | 06/14/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LC0974 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |