Provider Demographics
NPI:1427239425
Name:TESLA-DOYLE, BRIANNE N (LCPC)
Entity type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:N
Last Name:TESLA-DOYLE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4501
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-0501
Mailing Address - Country:US
Mailing Address - Phone:240-818-8911
Mailing Address - Fax:
Practice Address - Street 1:181 MICHELLE DR
Practice Address - Street 2:
Practice Address - City:HEDGESVILLE
Practice Address - State:WV
Practice Address - Zip Code:25427-5886
Practice Address - Country:US
Practice Address - Phone:240-818-8911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3476101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional