Provider Demographics
NPI:1457702581
Name:DONNELLY, TESSA (MED, BCBA)
Entity Type:Individual
Prefix:MS
First Name:TESSA
Middle Name:
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 EISENHOWER AVE APT 114
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4876
Mailing Address - Country:US
Mailing Address - Phone:814-312-7825
Mailing Address - Fax:
Practice Address - Street 1:5040 EISENHOWER AVE APT 114
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4876
Practice Address - Country:US
Practice Address - Phone:814-312-7825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst