Provider Demographics
NPI:1275896961
Name:TALIERCO, TERESA MARGARET (MA,LPC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARGARET
Last Name:TALIERCO
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 ARLINGTON BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4620
Mailing Address - Country:US
Mailing Address - Phone:703-300-4434
Mailing Address - Fax:703-533-8098
Practice Address - Street 1:8550 ARLINGTON BLVD STE 310
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4620
Practice Address - Country:US
Practice Address - Phone:703-300-4434
Practice Address - Fax:703-533-8098
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002223101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist