Provider Demographics
NPI:1467758086
Name:CORREIA, TERESA DIANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:DIANNE
Last Name:CORREIA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5903 MOUNT EAGLE DR APT 214
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-2526
Mailing Address - Country:US
Mailing Address - Phone:203-232-0203
Mailing Address - Fax:
Practice Address - Street 1:500 CADMUS LN STE 203
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-4094
Practice Address - Country:US
Practice Address - Phone:410-873-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005375103TC0700X, 103TC0700X
MD06377103T00000X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist