Provider Demographics
NPI:1265860787
Name:PEAK NEUROTRAINING SOLUTIONS, INC
Entity Type:Organization
Organization Name:PEAK NEUROTRAINING SOLUTIONS, INC
Other - Org Name:PEAK NT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:DUROUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-606-0670
Mailing Address - Street 1:107 E HOLLY AVE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-5405
Mailing Address - Country:US
Mailing Address - Phone:703-444-7325
Mailing Address - Fax:703-444-7325
Practice Address - Street 1:107 E HOLLY AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-5405
Practice Address - Country:US
Practice Address - Phone:703-444-7325
Practice Address - Fax:703-444-7325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003784103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty