Provider Demographics
NPI:1215315841
Name:KIMBALL, TERI ANN (MA)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:ANN
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23115 LEARNING CIR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-6470
Mailing Address - Country:US
Mailing Address - Phone:571-252-2414
Mailing Address - Fax:
Practice Address - Street 1:23115 LEARNING CIR
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20148-6470
Practice Address - Country:US
Practice Address - Phone:571-252-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool