Provider Demographics
NPI:1982030862
Name:KOLSCH, DENNIS (MA)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:KOLSCH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 S ORLANDO AVE
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-2340
Mailing Address - Country:US
Mailing Address - Phone:321-423-1212
Mailing Address - Fax:321-593-0646
Practice Address - Street 1:1811 S ORLANDO AVE
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-2340
Practice Address - Country:US
Practice Address - Phone:321-423-1212
Practice Address - Fax:321-593-0646
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLMH13258101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor