Basic Information
Provider Information | |||||||||
NPI: | 1114322013 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MOLOKIN | ||||||||
FirstName: | VICKTORIA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCPC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | TOKMAN | ||||||||
OtherFirstName: | VICKTORIA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LGPC | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 118 MONROE ST APT 904 | ||||||||
Address2: |   | ||||||||
City: | ROCKVILLE | ||||||||
State: | MD | ||||||||
PostalCode: | 208502513 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3015027430 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 7474 GREENWAY CENTER DR | ||||||||
Address2: | SUITE 730 | ||||||||
City: | GREENBELT | ||||||||
State: | MD | ||||||||
PostalCode: | 20770 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3013457022 | ||||||||
FaxNumber: | 2405542505 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/04/2014 | ||||||||
LastUpdateDate: | 02/19/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | LC7099 | MD | Y |   | Behavioral Health & Social Service Providers | Counselor |   |
No ID Information.