Healthcare Provider Details

I. General information

NPI: 1609955053
Provider Name (Legal Business Name): JANET G KOWALSKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 ROGERS ST SUITE 103
BLAIRSVILLE GA
30512-8507
US

IV. Provider business mailing address

PO BOX 186
BLAIRSVILLE GA
30514-0186
US

V. Phone/Fax

Practice location:
  • Phone: 706-781-6035
  • Fax: 706-374-4222
Mailing address:
  • Phone: 706-781-6035
  • Fax: 706-374-4222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC 003586
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: