Healthcare Provider Details

I. General information

NPI: 1225576879
Provider Name (Legal Business Name): CHRISTINE KOBIK MA, AT, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 CROWE AVE
MARS PA
16046-3303
US

IV. Provider business mailing address

120 GOLDSCHEITTER RD
SARVER PA
16055-9614
US

V. Phone/Fax

Practice location:
  • Phone: 415-816-6637
  • Fax:
Mailing address:
  • Phone: 415-816-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC009316
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: