Provider Demographics
NPI:1538313069
Name:KOJACK, CORINA H (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CORINA
Middle Name:H
Last Name:KOJACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62018
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23466-2018
Mailing Address - Country:US
Mailing Address - Phone:757-631-0099
Mailing Address - Fax:757-631-4971
Practice Address - Street 1:4937 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5301
Practice Address - Country:US
Practice Address - Phone:757-631-0099
Practice Address - Fax:757-631-4971
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004404101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional