Healthcare Provider Details

I. General information

NPI: 1386721355
Provider Name (Legal Business Name): JAMES CHARLES KOWALSKI LPC, MAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 EDGEWATER DR UNIT 604
DUNEDIN FL
34698-6965
US

IV. Provider business mailing address

620 EDGEWATER DR UNIT 604
DUNEDIN FL
34698-6965
US

V. Phone/Fax

Practice location:
  • Phone: 706-835-6515
  • Fax: 706-835-6515
Mailing address:
  • Phone: 706-835-6515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2066
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC4433
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC003377
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: