Provider Demographics
NPI:1205166246
Name:SERGEEVYKH, NIKOLAY N (LCPC)
Entity type:Individual
Prefix:
First Name:NIKOLAY
Middle Name:N
Last Name:SERGEEVYKH
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-4219
Mailing Address - Country:US
Mailing Address - Phone:443-869-6512
Mailing Address - Fax:
Practice Address - Street 1:809 FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227-4219
Practice Address - Country:US
Practice Address - Phone:443-869-6512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3110101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional