Provider Demographics
NPI:1528694510
Name:KOVAREK, CHRISANDRA L (LCSW-S)
Entity type:Individual
Prefix:
First Name:CHRISANDRA
Middle Name:L
Last Name:KOVAREK
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BELLE LN
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-2014
Mailing Address - Country:US
Mailing Address - Phone:361-676-3620
Mailing Address - Fax:
Practice Address - Street 1:301 BELLE LN
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-2014
Practice Address - Country:US
Practice Address - Phone:361-676-3620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-21
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX387001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty