Provider Demographics
NPI:1134853427
Name:BHASIN, KOVITA SANJAY (MS, APC, NCC)
Entity type:Individual
Prefix:
First Name:KOVITA
Middle Name:SANJAY
Last Name:BHASIN
Suffix:
Gender:F
Credentials:MS, APC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1677 MARAKANDA TRL
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-2956
Mailing Address - Country:US
Mailing Address - Phone:612-666-5453
Mailing Address - Fax:
Practice Address - Street 1:1355 TERRELL MILL RD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5496
Practice Address - Country:US
Practice Address - Phone:470-893-1052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008567101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor