Healthcare Provider Details

I. General information

NPI: 1790010601
Provider Name (Legal Business Name): KRISTINA KOTECHA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOLBROOK RD
HAVERTOWN PA
19083-5726
US

IV. Provider business mailing address

24 HOLBROOK RD
HAVERTOWN PA
19083-5726
US

V. Phone/Fax

Practice location:
  • Phone: 267-257-0923
  • Fax:
Mailing address:
  • Phone: 267-257-0923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC005213
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: