Provider Demographics
NPI:1437806593
Name:DR T CORREIA, LLC
Entity Type:Organization
Organization Name:DR T CORREIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:CORREIA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:571-969-2367
Mailing Address - Street 1:406 BLENNY LN
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619-9513
Mailing Address - Country:US
Mailing Address - Phone:571-969-2367
Mailing Address - Fax:571-257-9042
Practice Address - Street 1:406 BLENNY LN
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-9513
Practice Address - Country:US
Practice Address - Phone:571-969-2367
Practice Address - Fax:571-257-9042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health