Provider Demographics
NPI:1487604237
Name:COURTILLET, THERESA A (LPC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:COURTILLET
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 FOXBORO CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-4209
Mailing Address - Country:US
Mailing Address - Phone:703-273-6800
Mailing Address - Fax:703-273-2038
Practice Address - Street 1:9506B LEE HWY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2303
Practice Address - Country:US
Practice Address - Phone:703-273-6800
Practice Address - Fax:703-273-2038
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003042101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional