Provider Demographics
NPI:1700636537
Name:KOUCHINSKY, MARI-PEYTON (LPC)
Entity Type:Individual
Prefix:
First Name:MARI-PEYTON
Middle Name:
Last Name:KOUCHINSKY
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 1:309 MARY GRAY LN
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-5030
Mailing Address - Country:US
Mailing Address - Phone:540-490-0389
Mailing Address - Fax:
Practice Address - Street 1:15 PRATTS RUN STE 104
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-6606
Practice Address - Country:US
Practice Address - Phone:540-609-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013385101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional