Healthcare Provider Details

I. General information

NPI: 1053718502
Provider Name (Legal Business Name): VIKTORIYA KARAKCHEYEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2014
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date: 02/07/2017
Reactivation Date: 07/18/2018

III. Provider practice location address

2600 VIRGINIA AVE NW STE 300
WASHINGTON DC
20037-1926
US

IV. Provider business mailing address

200 WOOD HILL RD
ROCKVILLE MD
20850-8724
US

V. Phone/Fax

Practice location:
  • Phone: 202-994-2502
  • Fax: 202-242-9971
Mailing address:
  • Phone: 301-838-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC4293
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC200001310
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: