Provider Demographics
NPI:1588227037
Name:KOTSAKIS, ANASTASIA (LCPC)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:KOTSAKIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:MORNINGSIDE
Mailing Address - State:MD
Mailing Address - Zip Code:20746-3512
Mailing Address - Country:US
Mailing Address - Phone:240-795-6595
Mailing Address - Fax:
Practice Address - Street 1:4104 MAPLE RD
Practice Address - Street 2:
Practice Address - City:MORNINGSIDE
Practice Address - State:MD
Practice Address - Zip Code:20746-3512
Practice Address - Country:US
Practice Address - Phone:240-795-6595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2023-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC11505101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD209475400Medicaid