Provider Demographics
NPI:1558038976
Name:POPOV, KRISTIAN (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:
Last Name:POPOV
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18053 CACTUS CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3817
Mailing Address - Country:US
Mailing Address - Phone:301-675-6458
Mailing Address - Fax:
Practice Address - Street 1:11670 OLD NATIONAL PIKE STE 103
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-6123
Practice Address - Country:US
Practice Address - Phone:301-865-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11828101YP2500X
MDLC14219101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional