=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730608530
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARA ELIZABETH KOVACH LCSWA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2017
-----------------------------------------------------
Last Update Date | 09/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1316 PATTON AVE STE D
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28806-2652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-306-1231
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 99 ASCENSION DR APT H111
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28806-1994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-306-1231
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | P011065
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------