Potomac Shores Mental Health & Wellness LLC
NPI 1902562507 · Psychiatric/Mental Health Nurse Practitioner · Woodbridge, VA
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Potomac Shores Mental Health & Wellness LLC is a Psychiatric/Mental Health Nurse Practitioner organization in Woodbridge, VA (NPI 1902562507).
Provider details
- NPI number
- 1902562507
- Entity type
- Organization
- Primary specialty
- Psychiatric/Mental Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Ebunola Ayoola, Owner(202) 809-3550
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
4 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
3 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Additional practice locations (2)
- 1401 21st St # 7927Sacramento, CA 95811-5226Phone: (888) 602-4957
- 7777 Leesburg Pike Ste 305sFalls Church, VA 22043-2443Phone: (703) 977-6556Fax: (703) 997-1490
Registry dates
- Enumerated
- 2021-11-09
- Last updated
- 2025-05-02
- Certified
- 2025-05-02
Frequently asked questions
- What is Potomac Shores Mental Health & Wellness LLC's NPI number?
- Potomac Shores Mental Health & Wellness LLC's National Provider Identifier (NPI) is 1902562507, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Potomac Shores Mental Health & Wellness LLC?
- Potomac Shores Mental Health & Wellness LLC is classified in the NPPES registry as Psychiatric/Mental Health Nurse Practitioner (Physician Assistants & Advanced Practice Nursing Providers).
- Where is Potomac Shores Mental Health & Wellness LLC located?
- Potomac Shores Mental Health & Wellness LLC's practice location on file with NPPES is 13000 Harbor Center Dr Ste 103, Woodbridge, VA 22192-2847.
- What is Potomac Shores Mental Health & Wellness LLC's phone number?
- The practice phone number listed in the NPPES registry for Potomac Shores Mental Health & Wellness LLC is (703) 977-6556.
- Does Potomac Shores Mental Health & Wellness LLC accept Medicare?
- Potomac Shores Mental Health & Wellness LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Potomac Shores Mental Health & Wellness LLC?
- The authorized official listed on Potomac Shores Mental Health & Wellness LLC's NPPES record is Ebunola Ayoola, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Potomac Shores Mental Health & Wellness LLC's NPI active?
- Yes — Potomac Shores Mental Health & Wellness LLC's NPI (1902562507) is active in the NPPES registry as of the last update on 2025-05-02.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.