Provider Demographics
NPI:1740669910
Name:DUCOAT, ILISSA JAE (LPC, FT)
Entity type:Individual
Prefix:MS
First Name:ILISSA
Middle Name:JAE
Last Name:DUCOAT
Suffix:
Gender:F
Credentials:LPC, FT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 W BROAD ST STE 500
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1018
Mailing Address - Country:US
Mailing Address - Phone:267-227-0741
Mailing Address - Fax:
Practice Address - Street 1:1534 W BROAD ST STE 500
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1018
Practice Address - Country:US
Practice Address - Phone:267-227-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008126101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional