Provider Demographics
NPI:1053968214
Name:SOVULEWSKI, KESAMYN (LCPC, LCADC)
Entity type:Individual
Prefix:
First Name:KESAMYN
Middle Name:
Last Name:SOVULEWSKI
Suffix:
Gender:F
Credentials:LCPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-5601
Mailing Address - Country:US
Mailing Address - Phone:406-579-0410
Mailing Address - Fax:
Practice Address - Street 1:615 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5601
Practice Address - Country:US
Practice Address - Phone:406-579-0410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV06305-LC101YA0400X
NVCP5141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)