Provider Demographics
NPI:1477048429
Name:TEDESCHI, KATHRYN HILLARY (ATR-BC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:HILLARY
Last Name:TEDESCHI
Suffix:
Gender:F
Credentials:ATR-BC, LPC
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:HILLARY
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATR-BC, LPC
Mailing Address - Street 1:2661 HORTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2510
Mailing Address - Country:US
Mailing Address - Phone:703-798-6291
Mailing Address - Fax:
Practice Address - Street 1:11250 ROGER BACON DR BLDG 10
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5219
Practice Address - Country:US
Practice Address - Phone:703-962-7206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14648101YP2500X
VA0701007801101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701007801OtherBOARD OF COUNSELING