Provider Demographics
NPI:1780950592
Name:POTOMAC BEHAVIORAL SOLUTIONS
Entity type:Organization
Organization Name:POTOMAC BEHAVIORAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:571-257-3378
Mailing Address - Street 1:2001 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3603
Mailing Address - Country:US
Mailing Address - Phone:571-257-3378
Mailing Address - Fax:571-257-0906
Practice Address - Street 1:2001 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 211
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-3603
Practice Address - Country:US
Practice Address - Phone:571-257-3378
Practice Address - Fax:571-257-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004539103TC0700X
133V00000X
VA0810004487103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty