Healthcare Provider Details

I. General information

NPI: 1285791723
Provider Name (Legal Business Name): RIVERSIDE COUSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44084 RIVERSIDE PARKWAY 240
LEESBURG VA
20176
US

IV. Provider business mailing address

44084 RIVERSIDE PARKWAY 240
LEESBURG VA
20176
US

V. Phone/Fax

Practice location:
  • Phone: 703-724-0200
  • Fax: 703-724-4093
Mailing address:
  • Phone: 703-724-0200
  • Fax: 703-724-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DONALD PENN HALL JR.
Title or Position: PSYCHIATRIST PRACTICE OWNER
Credential: MD
Phone: 703-724-0200