Provider Demographics
NPI:1518261908
Name:POPOV, CHARLES J (LPC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:POPOV
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:TURIN
Mailing Address - State:GA
Mailing Address - Zip Code:30289-0302
Mailing Address - Country:US
Mailing Address - Phone:770-668-3130
Mailing Address - Fax:
Practice Address - Street 1:145 GOVERNORS SQ STE A
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4861
Practice Address - Country:US
Practice Address - Phone:770-668-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003014588Medicaid