Provider Demographics
NPI:1376351171
Name:TEITSMA, ALYSSA (LPC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:TEITSMA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12102 QUORN LN
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-2625
Mailing Address - Country:US
Mailing Address - Phone:703-966-2680
Mailing Address - Fax:
Practice Address - Street 1:443B CARLISLE DR STE 204
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4802
Practice Address - Country:US
Practice Address - Phone:703-966-2680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701014324101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health