1710076161 NPI number — TERESINA M S CHRISTY LPC LMFT

Table of content: TERESINA M S CHRISTY LPC LMFT (NPI 1710076161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710076161 NPI number — TERESINA M S CHRISTY LPC LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTY
Provider First Name:
TERESINA
Provider Middle Name:
M S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710076161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10555 MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22030-3306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-352-8533
Provider Business Mailing Address Fax Number:
703-237-6780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10555 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22030-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-352-8533
Provider Business Practice Location Address Fax Number:
703-237-6780
Provider Enumeration Date:
10/12/2006

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: 101YP2500X , with the licence number:  0701001836 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 0717000488 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 091585 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 00250001 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 217463 . This is a "KAISER PERMANENTE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18166 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5782081 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 323251 . This is a "TRICARE MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 006360 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".




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