Provider Demographics
NPI:1669047635
Name:KOCOL, CHRISTINA (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:KOCOL
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 1:4720 LARCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-2026
Mailing Address - Country:US
Mailing Address - Phone:414-899-6110
Mailing Address - Fax:
Practice Address - Street 1:4720 LARCHWOOD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-2026
Practice Address - Country:US
Practice Address - Phone:414-899-6110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health