Provider Demographics
NPI:1497296776
Name:REYES CASTILLO, TERESA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:J
Last Name:REYES CASTILLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:20905 PROFESSIONAL PLZ
Mailing Address - Street 2:STE 220
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-7783
Mailing Address - Country:US
Mailing Address - Phone:703-858-9841
Mailing Address - Fax:703-858-9446
Practice Address - Street 1:20905 PROFESSIONAL PLZ
Practice Address - Street 2:STE 220
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7783
Practice Address - Country:US
Practice Address - Phone:703-858-9841
Practice Address - Fax:703-858-9446
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0810005657103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical