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General NPI Number Information
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NPI Number | 1487908943
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Entity Type | Organization
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Legal Business Name | COURTNEE PELTON, PSY.D, LLC
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 6830 ELM ST STE. 9
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City | MC LEAN
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State | VA
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Zip | 22101-3874
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Country | US
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Telephone | 703-343-0849
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Fax |
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Provider Business Mailing Address
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Address Line | 6830 ELM ST STE. 9
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City | MC LEAN
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State | VA
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Zip | 22101-3874
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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 | CLINICAL PSYCHOLOGIST
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Name | DR. COURTNEE PELTON
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Credential | PSY.D
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Telephone | 703-343-0849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 0810004219
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License Number State | VA
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