Basic Information
| Provider Information | |||||||||
| NPI: | 1861557381 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POPOV | ||||||||
| FirstName: | DUBLIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | POPOV | ||||||||
| OtherFirstName: | DUBLIN | ||||||||
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| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 165 MARIETTA ST SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973025087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033041712 | ||||||||
| FaxNumber: | 5033629671 | ||||||||
| Practice Location | |||||||||
| Address1: | 821 SAGINAW ST S | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973024121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033621999 | ||||||||
| FaxNumber: | 5033629671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 05/03/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 3879 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.