Provider Demographics
NPI:1881329506
Name:TESSEMA, SELAM
Entity type:Individual
Prefix:
First Name:SELAM
Middle Name:
Last Name:TESSEMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5337 RANDOLPH RD APT 1
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2136
Mailing Address - Country:US
Mailing Address - Phone:202-848-8009
Mailing Address - Fax:
Practice Address - Street 1:12200 PLUM ORCHARD DR STE 120A
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7843
Practice Address - Country:US
Practice Address - Phone:240-597-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician