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General NPI Number Information
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NPI Number | 1265860787
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Entity Type | Organization
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Legal Business Name | PEAK NEUROTRAINING SOLUTIONS, INC
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Dates
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Enumeration Date | 10/18/2013
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 107 E HOLLY AVE SUITE 13
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City | STERLING
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State | VA
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Zip | 20164-5405
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Country | US
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Telephone | 703-444-7325
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Fax | 703-444-7325
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Provider Business Mailing Address
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Address Line | 107 E HOLLY AVE SUITE 13
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City | STERLING
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State | VA
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Zip | 20164-5405
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Country | US
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Telephone | 703-444-7325
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Fax | 703-444-7325
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DONALD RICHARD DUROUSSEAU
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Credential |
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Telephone | 703-606-0670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 0810003784
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License Number State | VA
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