Provider Demographics
NPI:1023366200
Name:TEBOR, STEPHANIE HUSIK (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:HUSIK
Last Name:TEBOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6723 WHITTIER AVE
Mailing Address - Street 2:SUITE 405-C
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4522
Mailing Address - Country:US
Mailing Address - Phone:703-508-4836
Mailing Address - Fax:703-908-8834
Practice Address - Street 1:6723 WHITTIER AVE
Practice Address - Street 2:SUITE 405-C
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4522
Practice Address - Country:US
Practice Address - Phone:703-508-4836
Practice Address - Fax:703-908-8834
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003321103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical