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Organization
POTOMAC PSYCHOLOGICAL CENTER, LLC
Active
Organization
POTOMAC PSYCHOLOGICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICK GENTILE LPC (PRESIDENT)
(703) 858-7838
Entity
Organization
Contact information
Practice address
20925 PROFESSIONAL PLZ, SUITE 230, ASHBURN, VA 20147-3403
(703) 858-7838
(703) 858-9697
Mailing address
20925 PROFESSIONAL PLZ, SUITE 230, ASHBURN, VA 20147-3403
(703) 858-7838
(703) 858-9697
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701003403
VA
103TC0700X
Clinical Psychologist
0810003656
VA
1041C0700X
Clinical Social Worker
0904004863
VA
2084P0800X
Psychiatry Physician
0101231051
VA
2084P0804X
Child & Adolescent Psychiatry Physician
0101241532
VA
Other
Enumeration date
07/07/2009
Last updated
07/07/2009
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