| Potomac Center Inc | |
|
5500 Holmes Run Pkwy Ste C4 Alexandria VA 22304-2863 | |
| (703) 379-7350 | |
| (703) 379-7352 |
| Full Name | Potomac Center Inc |
|---|---|
| Speciality | Counselor |
| Location | 5500 Holmes Run Pkwy, Alexandria, Virginia |
| Authorized Official Name and Position | Nathalie Gallet (VP) |
| Authorized Official Contact | 7053797350 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Potomac Center Inc 5500 Holmes Run Pkwy Suite C4 Alexandria VA 22304-2863 Ph: (703) 379-7350 | Potomac Center Inc 5500 Holmes Run Pkwy Ste C4 Alexandria VA 22304-2863 Ph: (703) 379-7350 |
| NPI Number | 1457403099 |
|---|---|
| Provider Enumeration Date | 01/16/2007 |
| Last Update Date | 09/14/2016 |
| Medicare PECOS PAC ID | 2860484094 |
|---|---|
| Medicare Enrollment ID | O20040330001518 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457403099 | NPI | - | NPPES |
| Provider Name | Daniel Donnelly |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891849048 PECOS PAC ID: 8426210154 Enrollment ID: I20120425000713 |
| Provider Name | Thomas J Neal |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174593412 PECOS PAC ID: 1658302526 Enrollment ID: I20141007001547 |
| Provider Name | Scott Krysztofiak |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801284682 PECOS PAC ID: 6305146101 Enrollment ID: I20151201000842 |
| Provider Name | Daniela Sosa-sarkar |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760948095 PECOS PAC ID: 4587091863 Enrollment ID: I20200226001581 |
| Provider Name | Sarunporn (jay) Sirikietsoong |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871802314 PECOS PAC ID: 6103254073 Enrollment ID: I20200309001109 |
| Provider Name | Debra Gillum |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649365503 PECOS PAC ID: 0042290603 Enrollment ID: I20200316000998 |
| Provider Name | Eugene A. Shooter, Jr. |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720024821 PECOS PAC ID: 1153736525 Enrollment ID: I20210217000061 |
| Provider Name | Paul Richard Marion |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538655873 PECOS PAC ID: 1052769387 Enrollment ID: I20231128001345 |
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