Provider Demographics
NPI:1043231913
Name:GEORGE, TERESA ANN (MA,LPC,NCC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MA,LPC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SHOREVIEW RD
Mailing Address - Street 2:
Mailing Address - City:TRIANGLE
Mailing Address - State:VA
Mailing Address - Zip Code:22172-1514
Mailing Address - Country:US
Mailing Address - Phone:301-832-4020
Mailing Address - Fax:
Practice Address - Street 1:2501 HUNTER PL STE 202
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-3940
Practice Address - Country:US
Practice Address - Phone:571-365-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1385101YP2500X
WV836103T00000X
VA0701007985101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9202128000Medicaid