Provider Demographics
NPI:1427422385
Name:LOUDOUN PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:LOUDOUN PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELSDORF
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:703-297-4368
Mailing Address - Street 1:217 S KING ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-2905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:217 S KING ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-2905
Practice Address - Country:US
Practice Address - Phone:703-297-4368
Practice Address - Fax:571-512-7955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005246103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1679600266OtherNPI
VA601050065Medicaid
VA600961320Medicaid
1104228121OtherNPI
1417312257OtherNPI
VA601076584Medicaid
VA601119488Medicaid
1275810764OtherNPI
1902353360OtherNPI
VA1194910562OtherNPI
1457808818OtherNPI