Provider Demographics
NPI:1831410869
Name:KONCILJA, KATHERINE (MA, LPCC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:KONCILJA
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MILLER RD STE 7
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1013
Mailing Address - Country:US
Mailing Address - Phone:440-742-1661
Mailing Address - Fax:440-653-9576
Practice Address - Street 1:215 MILLER RD STE 7
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1013
Practice Address - Country:US
Practice Address - Phone:440-742-1661
Practice Address - Fax:440-653-9576
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1000011101YP2500X
OH090037101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)