Provider Demographics
NPI:1669675104
Name:GEORGOPOULOS, JOHN (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:GEORGOPOULOS
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 1:2302 GALLOWS RD
Mailing Address - Street 2:64
Mailing Address - City:DUNN LORING
Mailing Address - State:VA
Mailing Address - Zip Code:22027-1148
Mailing Address - Country:US
Mailing Address - Phone:703-207-1084
Mailing Address - Fax:
Practice Address - Street 1:1313 VINCENT PL
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3615
Practice Address - Country:US
Practice Address - Phone:703-207-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC810101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA07150032287OtherCERTIFIED REHABILITATION