Healthcare Provider Details

I. General information

NPI: 1619689189
Provider Name (Legal Business Name): TESSA VICTORIA RUBY SMITH MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5691 COLUMBIA PIKE STE 200
FALLS CHURCH VA
22041-2888
US

IV. Provider business mailing address

5691 COLUMBIA PIKE STE 200
FALLS CHURCH VA
22041-2888
US

V. Phone/Fax

Practice location:
  • Phone: 240-583-0529
  • Fax:
Mailing address:
  • Phone: 240-583-0529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number08100009181
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: