Provider Demographics
NPI:1407533698
Name:PEAK POTENTIAL PERSONAL DEVELOPMENT, LLC
Entity Type:Organization
Organization Name:PEAK POTENTIAL PERSONAL DEVELOPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:703-596-9574
Mailing Address - Street 1:6025 ERINBLAIR LOOP
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-2613
Mailing Address - Country:US
Mailing Address - Phone:703-283-2394
Mailing Address - Fax:
Practice Address - Street 1:6025 ERINBLAIR LOOP
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-2613
Practice Address - Country:US
Practice Address - Phone:703-283-2394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty