Provider Demographics
NPI:1396842043
Name:ANCELLOTTI, TERESA BUCHANAN (PHD, LMFT, LPC)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:BUCHANAN
Last Name:ANCELLOTTI
Suffix:
Gender:F
Credentials:PHD, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1769 JAMESTOWN RD.
Mailing Address - Street 2:STE. 102 JAMESTOWNE PROFESSIONAL PARK
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185
Mailing Address - Country:US
Mailing Address - Phone:757-608-8659
Mailing Address - Fax:757-932-6020
Practice Address - Street 1:1769 JAMESTOWN RD.
Practice Address - Street 2:STE. 102 JAMESTOWNE PROFESSIONAL PARK
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185
Practice Address - Country:US
Practice Address - Phone:757-608-8659
Practice Address - Fax:757-932-6020
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002331101YP2500X
VA0701092331101YP2500X
103TS0200X
VA0717000232106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA070916OtherVALUE OPTIONS
VA245771OtherANTHEM
VA455651000OtherMAGELLAN
VA52891OtherCIGNA
VA081408OtherOPTIMA
VA100050909OtherAPS HEALTHCARE
VA5414105Medicaid