Healthcare Provider Details

I. General information

NPI: 1083403984
Provider Name (Legal Business Name): POLESTAR PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 RIDGE RD
WASHINGTON GROVE MD
20880-2000
US

IV. Provider business mailing address

PO BOX 843
WASHINGTON GROVE MD
20880-0843
US

V. Phone/Fax

Practice location:
  • Phone: 202-710-6883
  • Fax:
Mailing address:
  • Phone: 202-710-6883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: YULIA RYCHKOVA
Title or Position: OWNER AND THERAPIST
Credential: LCSWC
Phone: 202-710-6883