Healthcare Provider Details

I. General information

NPI: 1497683429
Provider Name (Legal Business Name): POLARIS EMBER THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21000 SOUTHBANK ST STE 106
POTOMAC FALLS VA
20165-7242
US

IV. Provider business mailing address

21000 SOUTHBANK ST STE 106
POTOMAC FALLS VA
20165-7242
US

V. Phone/Fax

Practice location:
  • Phone: 703-375-9059
  • Fax:
Mailing address:
  • Phone: 703-375-9059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ALLISON BROWN
Title or Position: OWNER
Credential: LPC
Phone: 240-778-5060