Healthcare Provider Details

I. General information

NPI: 1992471932
Provider Name (Legal Business Name): CHRISTOPHER DAVID KOTCH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VA CTR
AUGUSTA ME
04330-6795
US

IV. Provider business mailing address

1 VA CTR
AUGUSTA ME
04330-6795
US

V. Phone/Fax

Practice location:
  • Phone: 207-530-0444
  • Fax:
Mailing address:
  • Phone: 207-771-3545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number18009
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: