Provider Demographics
NPI:1790010601
Name:KOTECHA, KRISTINA (LPC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:KOTECHA
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 1:24 HOLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5726
Mailing Address - Country:US
Mailing Address - Phone:267-257-0923
Mailing Address - Fax:
Practice Address - Street 1:24 HOLBROOK RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5726
Practice Address - Country:US
Practice Address - Phone:267-257-0923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005213101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional