Provider Demographics
NPI:1427829795
Name:POZZO DI BORGO, TESSA
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:POZZO DI BORGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NOX
Other - Middle Name:
Other - Last Name:POZZO DI BORGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14428 ALBEMARLE POINT PL STE 150B
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1752
Mailing Address - Country:US
Mailing Address - Phone:703-712-7622
Mailing Address - Fax:
Practice Address - Street 1:14428 ALBEMARLE POINT PL STE 150B
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1752
Practice Address - Country:US
Practice Address - Phone:703-712-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty