Provider Demographics
NPI:1629835996
Name:POPOV, JESSICA BLAIR (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BLAIR
Last Name:POPOV
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:JEAN
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 BENNETT RD # D
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6008
Mailing Address - Country:US
Mailing Address - Phone:407-637-6348
Mailing Address - Fax:
Practice Address - Street 1:1100 N FERN CREEK AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-2628
Practice Address - Country:US
Practice Address - Phone:407-637-6348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health