Healthcare Provider Details

I. General information

NPI: 1851983530
Provider Name (Legal Business Name): TESSA WIMBERLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/06/2022
Certification Date: 02/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8705 COLESVILLE RD STE B #213
SILVER SPRING MD
20910-3903
US

IV. Provider business mailing address

8705 COLESVILLE RD STE B #213
SILVER SPRING MD
20910-3903
US

V. Phone/Fax

Practice location:
  • Phone: 301-458-0690
  • Fax:
Mailing address:
  • Phone: 301-458-0690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number06033
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: