Provider Demographics
NPI:1356639637
Name:KOVACH, MISTY MARIE (MA, LPC, CAADC)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:MARIE
Last Name:KOVACH
Suffix:
Gender:F
Credentials:MA, LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4232 NORTHERN PIKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2732
Mailing Address - Country:US
Mailing Address - Phone:412-663-0062
Mailing Address - Fax:412-202-1705
Practice Address - Street 1:4232 NORTHERN PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2732
Practice Address - Country:US
Practice Address - Phone:412-663-0062
Practice Address - Fax:412-202-1705
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PAPC006043101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)