Provider Demographics
NPI:1215651690
Name:POTOMAC PSYCHIATRIC WELLNESS PA
Entity type:Organization
Organization Name:POTOMAC PSYCHIATRIC WELLNESS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HOPKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-599-0811
Mailing Address - Street 1:11436 BEECHGROVE LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1801
Mailing Address - Country:US
Mailing Address - Phone:301-580-2252
Mailing Address - Fax:240-238-8580
Practice Address - Street 1:1201 SEVEN LOCKS RD STE 360
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-6901
Practice Address - Country:US
Practice Address - Phone:240-599-0811
Practice Address - Fax:240-238-8580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center