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General NPI Number Information
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NPI Number | 1427422385
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Entity Type | Organization
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Legal Business Name | LOUDOUN PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 11/16/2015
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Last Update Date | 12/05/2018
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Provider Practice Location Address
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Address Line | 217 S KING ST
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City | LEESBURG
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State | VA
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Zip | 20175-2905
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Country | US
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Telephone | 703-297-4368
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Fax | 571-512-7955
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Provider Business Mailing Address
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Address Line | 217 S KING ST
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City | LEESBURG
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State | VA
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Zip | 20175-2905
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | DR. ERIC ZELSDORF
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Credential | PSYD
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Telephone | 703-297-4368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0810005246
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License Number State | VA
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