Provider Demographics
NPI:1154185700
Name:LOUKANARIS, ANASTASIA (NCC)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:LOUKANARIS
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:
Other - Last Name:GATOULIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NCC
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:MOUNT FREEDOM
Mailing Address - State:NJ
Mailing Address - Zip Code:07970-0581
Mailing Address - Country:US
Mailing Address - Phone:361-696-5464
Mailing Address - Fax:
Practice Address - Street 1:1250 SUSSEX TPKE UNIT 581
Practice Address - Street 2:
Practice Address - City:MOUNT FREEDOM
Practice Address - State:NJ
Practice Address - Zip Code:07970-7833
Practice Address - Country:US
Practice Address - Phone:361-696-5464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00850300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional