Provider Demographics
NPI:1679115349
Name:BOVA, DAVID S (LCPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:S
Last Name:BOVA
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 HAPPY LANDING DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-6259
Mailing Address - Country:US
Mailing Address - Phone:217-318-5539
Mailing Address - Fax:
Practice Address - Street 1:2200 LAKE VICTORIA DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5596
Practice Address - Country:US
Practice Address - Phone:217-529-9266
Practice Address - Fax:217-529-9151
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180014182101YM0800X
IL178014846101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178014846OtherSTATE LICENSE