Provider Demographics
NPI:1063303501
Name:PROFESSIONAL MENTAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:PROFESSIONAL MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASGHEDOM
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-B C
Authorized Official - Phone:240-285-9318
Mailing Address - Street 1:8511 BLUE BIRD WOODS CT
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1351
Mailing Address - Country:US
Mailing Address - Phone:240-285-9318
Mailing Address - Fax:
Practice Address - Street 1:172 THOMAS JOHNSON DR STE 203L2
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4402
Practice Address - Country:US
Practice Address - Phone:703-568-5059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-12
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty