Individual provider · NPI-1
Gueorgui Klissourov, PhD
Case Manager/Care Coordinator · Ashburn, VA
NPI number1073208070
StatusActive
Last updated in NPPESJul 27, 2023
Details
- NPI
- 1073208070
- Entity type
- Individual (NPI-1)
- Name
- Gueorgui Klissourov
- Credential
- PhD
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 6, 2023
- Certification date
- Jul 27, 2023
- Last updated
- Jul 27, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171M00000X | Case Manager/Care Coordinator | – | – | Yes |
| 251S00000X | Community/Behavioral Health | – | – |
Practice location
20116 Ashbrook PlAshburn, VA 20147-5086
Phone 540-630-1211
Mailing address
20116 Ashbrook PlAshburn, VA 20147-5086
Phone 540-630-1211
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