Healthcare Provider Details

I. General information

NPI: 1912831009
Provider Name (Legal Business Name): MARIYA PETROVNA POPOVA SUDP/T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2732 GRAND AVE STE 101
EVERETT WA
98201-3416
US

IV. Provider business mailing address

8102 EVERGREEN WAY APT C417
EVERETT WA
98203-6460
US

V. Phone/Fax

Practice location:
  • Phone: 425-322-0830
  • Fax: 425-259-0243
Mailing address:
  • Phone: 425-382-3883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: