Provider Demographics
NPI:1689360604
Name:HELLER, TERESA MARIE (MS, CGC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:HELLER
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CHARLES
Mailing Address - State:VA
Mailing Address - Zip Code:23310-3004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1971
Practice Address - Country:US
Practice Address - Phone:703-901-2562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0139000669170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS