Provider Demographics
NPI:1265551683
Name:KOCH, MICHAEL J
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:KOCH
Suffix:
Gender:M
Credentials:
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:116-118 NEW STATESIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-1165
Mailing Address - Country:US
Mailing Address - Phone:919-942-2803
Mailing Address - Fax:919-442-1842
Practice Address - Street 1:104 NEW STATESIDE DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-1165
Practice Address - Country:US
Practice Address - Phone:919-942-2803
Practice Address - Fax:919-942-2126
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)