Provider Demographics
NPI:1528801420
Name:GHEBREAB, TEKLE BERHANE
Entity type:Individual
Prefix:
First Name:TEKLE
Middle Name:BERHANE
Last Name:GHEBREAB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S WHITING ST APT 706
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-7135
Mailing Address - Country:US
Mailing Address - Phone:571-337-2606
Mailing Address - Fax:
Practice Address - Street 1:225 S WHITING ST APT 706
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-7135
Practice Address - Country:US
Practice Address - Phone:571-337-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty