Provider Demographics
NPI:1710076161
Name:CHRISTY, TERESINA M S (LPC LMFT)
Entity Type:Individual
Prefix:
First Name:TERESINA
Middle Name:M S
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10555 MAIN STREET
Mailing Address - Street 2:SUITE 230
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3306
Mailing Address - Country:US
Mailing Address - Phone:703-352-8533
Mailing Address - Fax:703-237-6780
Practice Address - Street 1:10555 MAIN ST
Practice Address - Street 2:SUITE 230
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3306
Practice Address - Country:US
Practice Address - Phone:703-352-8533
Practice Address - Fax:703-237-6780
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001836101YP2500X
VA0717000488106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA091585OtherANTHEM BCBS
DC00250001OtherCAREFIRST BCBS
217463OtherKAISER PERMANENTE
18166OtherNCPPO
5782081OtherAETNA
323251OtherTRICARE MHN
006360OtherVALUE OPTIONS