Provider Demographics
NPI:1275733941
Name:KOVALL, DEBORAH C (LADC, LPC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:C
Last Name:KOVALL
Suffix:
Gender:F
Credentials:LADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 WINDSOR ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120-2418
Mailing Address - Country:US
Mailing Address - Phone:860-560-5600
Mailing Address - Fax:860-527-3305
Practice Address - Street 1:675 TOWER AVE
Practice Address - Street 2:SUITE308
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1260
Practice Address - Country:US
Practice Address - Phone:860-714-9200
Practice Address - Fax:860-714-8516
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000529101YA0400X
CT000992101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional