Healthcare Provider Details

I. General information

NPI: 1891158267
Provider Name (Legal Business Name): LINA KOTSOEVA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 SAINT JOHNS LN STE F
ELLICOTT CITY MD
21042-2600
US

IV. Provider business mailing address

3355 SAINT JOHNS LN STE F
ELLICOTT CITY MD
21042-2600
US

V. Phone/Fax

Practice location:
  • Phone: 410-775-6270
  • Fax:
Mailing address:
  • Phone: 410-775-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC8639
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number00118053
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC8639
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number151947
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: