Healthcare Provider Details

I. General information

NPI: 1396842043
Provider Name (Legal Business Name): TERESA BUCHANAN ANCELLOTTI PHD, LMFT, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1769 JAMESTOWN RD. STE. 102 JAMESTOWNE PROFESSIONAL PARK
WILLIAMSBURG VA
23185
US

IV. Provider business mailing address

1769 JAMESTOWN RD. STE. 102 JAMESTOWNE PROFESSIONAL PARK
WILLIAMSBURG VA
23185
US

V. Phone/Fax

Practice location:
  • Phone: 757-608-8659
  • Fax: 757-932-6020
Mailing address:
  • Phone: 757-608-8659
  • Fax: 757-932-6020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002331
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701092331
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000232
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: