Provider Demographics
NPI:1215932678
Name:LEA, MICHAEL K (PHD, PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:LEA
Suffix:
Gender:M
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6045 SOLOMONS ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20639-8876
Mailing Address - Country:US
Mailing Address - Phone:410-257-5200
Mailing Address - Fax:410-257-2442
Practice Address - Street 1:6045 SOLOMONS ISLAND RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTOWN
Practice Address - State:MD
Practice Address - Zip Code:20639-8876
Practice Address - Country:US
Practice Address - Phone:410-257-5200
Practice Address - Fax:410-257-2442
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0974101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
F453-0001OtherCAREFIRST BLUECHOICE
604856-02OtherCAREFIRST BC/BS-MD