Provider Demographics
NPI:1053468181
Name:KOVALEV, VICTOR (MA, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:KOVALEV
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SURRY CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-1723
Mailing Address - Country:US
Mailing Address - Phone:609-324-9806
Mailing Address - Fax:609-324-9806
Practice Address - Street 1:2121 HIGHWAY 33
Practice Address - Street 2:LEXINGTON SQUARE COMMONS
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-1740
Practice Address - Country:US
Practice Address - Phone:609-324-9806
Practice Address - Fax:609-324-9806
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00005100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional