Individual
ANASTASIA KOUKOULIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA.T
Contact information
Practice address
3359 CHEVERLY CT, ABINGDON, MD 21009-2854
(727) 366-0323
Mailing address
3359 CHEVERLY COURT, ABINGDON, MD 21009
(727) 366-0323
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
Other
Enumeration date
06/11/2019
Last updated
06/11/2019
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