Provider Demographics
NPI:1417242157
Name:KNOVEREK, ANGEL (LCPC)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:KNOVEREK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1269 PLACE PLACE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4219
Mailing Address - Country:US
Mailing Address - Phone:217-440-6247
Mailing Address - Fax:
Practice Address - Street 1:131 N 4TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2913
Practice Address - Country:US
Practice Address - Phone:217-223-7492
Practice Address - Fax:217-223-7516
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL180005002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health