Organization
POTOMAC SHORES MENTAL HEALTH & WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBUNOLA MOIRA AYOOLA PHMNP (OWNER)
(202) 809-3550
Entity
Organization
Contact information
Practice address
13000 HARBOR CENTER DR STE 103, WOODBRIDGE, VA 22192-2847
(703) 977-6556
(703) 997-1490
Mailing address
13000 HARBOR CENTER DR STE 103, WOODBRIDGE, VA 22192-2847
(703) 977-6556
(703) 997-1490
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/09/2021
Last updated
05/02/2025
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