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General NPI Number Information
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NPI Number | 1184398778
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Entity Type | Individual
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Provider Name | NICOLE M TESKE PSYD
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Gender | Female
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Dates
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Enumeration Date | 08/06/2021
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 1875 CAMPUS COMMONS DR STE 225
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City | RESTON
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State | VA
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Zip | 20191-1533
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Country | US
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Telephone | 703-879-2482
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Fax |
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Provider Business Mailing Address
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Address Line | 11654 PLAZA AMERICA DR # 875
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City | RESTON
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State | VA
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Zip | 20190-4700
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Country | US
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Telephone | 703-879-2483
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810008344
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 07225
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP7013
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License Number State | MN
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