Healthcare Provider Details

I. General information

NPI: 1376912626
Provider Name (Legal Business Name): ANNA KHOLODNOV LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10410 KENSINGTON PKWY STE 223
KENSINGTON MD
20895-2947
US

IV. Provider business mailing address

14229 GEORGIA AVE APT 201
SILVER SPRING MD
20906-2761
US

V. Phone/Fax

Practice location:
  • Phone: 240-498-9867
  • Fax:
Mailing address:
  • Phone: 240-498-9867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMD17642
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: