Healthcare Provider Details

I. General information

NPI: 1669832036
Provider Name (Legal Business Name): MICHAEL KOTCH MA, LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 12/29/2024
Certification Date: 12/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 VIRGINIA BEACH BLVD # 219
VIRGINIA BEACH VA
23452-4419
US

IV. Provider business mailing address

3419 VIRGINIA BEACH BLVD # 219
VIRGINIA BEACH VA
23452-4419
US

V. Phone/Fax

Practice location:
  • Phone: 757-585-3273
  • Fax:
Mailing address:
  • Phone: 757-585-3273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00637400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010899
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: