Provider Demographics
NPI:1477280543
Name:KALUSIN, ZACHARY A (LGPC)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:A
Last Name:KALUSIN
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 MCGRATH BLVD APT 918
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-8663
Mailing Address - Country:US
Mailing Address - Phone:301-693-8444
Mailing Address - Fax:
Practice Address - Street 1:10400 CONNECTICUT AVE STE 311
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-3942
Practice Address - Country:US
Practice Address - Phone:301-693-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12231101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty