Provider Demographics
NPI:1861557381
Name:POPOV, DUBLIN (LCSW)
Entity type:Individual
Prefix:
First Name:DUBLIN
Middle Name:
Last Name:POPOV
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DUBLIN
Other - Middle Name:
Other - Last Name:POPOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:165 MARIETTA ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5087
Mailing Address - Country:US
Mailing Address - Phone:503-304-1712
Mailing Address - Fax:503-362-9671
Practice Address - Street 1:821 SAGINAW ST S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4121
Practice Address - Country:US
Practice Address - Phone:503-362-1999
Practice Address - Fax:503-362-9671
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR38791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical