Healthcare Provider Details

I. General information

NPI: 1194095067
Provider Name (Legal Business Name): NANCY LASITER KOZLOWSKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BREEDS HILL CT
LITTLE ROCK AR
72211-2514
US

IV. Provider business mailing address

11 BREEDS HILL CT
LITTLE ROCK AR
72211-2514
US

V. Phone/Fax

Practice location:
  • Phone: 501-352-2791
  • Fax:
Mailing address:
  • Phone: 501-352-2791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP0212047
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: