Provider Demographics
NPI:1710878657
Name:COUNCIL, THERESA (AUD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:COUNCIL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 W CLAY ST APT 715B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-4666
Mailing Address - Country:US
Mailing Address - Phone:267-230-8678
Mailing Address - Fax:
Practice Address - Street 1:430 MCLAWS CIR STE 101
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5655
Practice Address - Country:US
Practice Address - Phone:757-229-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201002027231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist