Provider Demographics
NPI:1184040594
Name:TUDDER, TERESA ELISA (MA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ELISA
Last Name:TUDDER
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 CALHOUN PL
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2790
Mailing Address - Country:US
Mailing Address - Phone:240-777-1277
Mailing Address - Fax:
Practice Address - Street 1:7300 CALHOUN PL
Practice Address - Street 2:SUITE 600
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-2790
Practice Address - Country:US
Practice Address - Phone:240-777-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3462101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional