Individual
GUEORGUI KLISSOUROV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
20116 ASHBROOK PL, ASHBURN, VA 20147-5086
(540) 630-1211
Mailing address
20116 ASHBROOK PL, ASHBURN, VA 20147-5086
(540) 630-1211
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
04/06/2023
Last updated
07/27/2023
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