Provider Demographics
NPI:1013208784
Name:BALOVLENKOV, KATRINA LOUISE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:LOUISE
Last Name:BALOVLENKOV
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9017 RED BRANCH RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2106
Mailing Address - Country:US
Mailing Address - Phone:410-730-4500
Mailing Address - Fax:
Practice Address - Street 1:9017 RED BRANCH RD
Practice Address - Street 2:SUITE 204
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2106
Practice Address - Country:US
Practice Address - Phone:410-730-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD168281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical