Healthcare Provider Details

I. General information

NPI: 1689289019
Provider Name (Legal Business Name): R. R. GORMAN, NP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 CHEROKEE AVE SUITE 300, #1084
ALEXANDRIA VA
22312
US

IV. Provider business mailing address

5510 CHEROKEE AVE SUITE 300, #1084
ALEXANDRIA VA
22312
US

V. Phone/Fax

Practice location:
  • Phone: 703-688-2588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: RYAN GORMAN
Title or Position: PMHNP
Credential: MSN, RN, PMHNP-BC
Phone: 703-688-2588