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Organization
PEAK PERFORMANCE NEUROFEEDBACK, LLC
Active
Organization
PEAK PERFORMANCE NEUROFEEDBACK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BETH B DAVIS PHD (PSYCHOLOGIST/CLINICAL DIRECTOR)
(619) 540-3235
Entity
Organization
Contact information
Practice address
13800 COPPERMINE RD, SUITE 183, HERNDON, VA 20171-6163
(619) 540-3235
(703) 234-2213
Mailing address
13800 COPPERMINE RD, SUITE 183, HERNDON, VA 20171-6163
(619) 540-3235
(703) 234-2213
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
0810004027
VA
261QM0850X
Adult Mental Health Clinic/Center
0810004027
VA
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
0810004027
VA
Other
Enumeration date
06/03/2015
Last updated
08/29/2016
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