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General NPI Number Information
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NPI Number | 1528798360
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Entity Type | Organization
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Legal Business Name | POTOMAC FAMILY COUNSELING, LLC
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 04/15/2024
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Provider Practice Location Address
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Address Line | 199 MAIN ST
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City | WARSAW
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State | VA
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Zip | 22572-5216
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Country | US
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Telephone | 703-665-0311
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Fax |
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Provider Business Mailing Address
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Address Line | 290 HAULOVER CIR
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City | MONTROSS
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State | VA
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Zip | 22520-8809
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Country | US
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Telephone | 703-606-2880
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | LYNETTE KAYE JACOB
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Credential | LCSW
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Telephone | 703-606-2880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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