Provider Demographics
NPI:1013666890
Name:MIKALIS, YIANNI (LCPC, LCPAT)
Entity type:Individual
Prefix:
First Name:YIANNI
Middle Name:
Last Name:MIKALIS
Suffix:
Gender:M
Credentials:LCPC, LCPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 S WOLFE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-3034
Mailing Address - Country:US
Mailing Address - Phone:240-715-7991
Mailing Address - Fax:
Practice Address - Street 1:624 S WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-3034
Practice Address - Country:US
Practice Address - Phone:240-715-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC14418101YP2500X
MDATC367221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist