Healthcare Provider Details

I. General information

NPI: 1427239425
Provider Name (Legal Business Name): BRIANNE N TESLA-DOYLE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 MICHELLE DR
HEDGESVILLE WV
25427-5886
US

IV. Provider business mailing address

PO BOX 4501
HAGERSTOWN MD
21742-0501
US

V. Phone/Fax

Practice location:
  • Phone: 240-818-8911
  • Fax:
Mailing address:
  • Phone: 240-818-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC3476
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: