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General NPI Number Information
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NPI Number | 1275733941
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Entity Type | Individual
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Provider Name | DEBORAH C. KOVALL LADC, LPC
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Gender | Female
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 675 TOWER AVE SUITE308
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City | HARTFORD
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State | CT
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Zip | 06112-1260
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Country | US
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Telephone | 860-714-9200
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Fax | 860-714-8516
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Provider Business Mailing Address
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Address Line | 555 WINDSOR ST
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City | HARTFORD
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State | CT
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Zip | 06120-2418
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Country | US
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Telephone | 860-560-5600
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Fax | 860-527-3305
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 000529
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 000992
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License Number State | CT
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