Healthcare Provider Details

I. General information

NPI: 1396308250
Provider Name (Legal Business Name): NATALIYA VLASOVA MA, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12023 EASTERN AVE
BALTIMORE MD
21220-1301
US

IV. Provider business mailing address

12023 EASTERN AVE
BALTIMORE MD
21220-1301
US

V. Phone/Fax

Practice location:
  • Phone: 443-676-1982
  • Fax: 443-451-8541
Mailing address:
  • Phone: 443-676-1982
  • Fax: 443-451-8541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC8329
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: