1326025131 NPI number — DR. TERESA DENISE KING PSYD

Table of content: DR. TERESA DENISE KING PSYD (NPI 1326025131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326025131 NPI number — DR. TERESA DENISE KING PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING
Provider First Name:
TERESA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSS
Provider Other First Name:
TERESA
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326025131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6107 HELLEN LEE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-3430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-534-2966
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CSOSA / RE-ENTRY & SANCTIONS CENTER
Provider Second Line Business Practice Location Address:
1900 MASSACHUSETTS AVENUE, BLDG. 17
Provider Business Practice Location Address City Name:
WASHINGTON DC
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-345-6949
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  2026 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)