Healthcare Provider Details

I. General information

NPI: 1750046645
Provider Name (Legal Business Name): KARI L PODWOSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5699 GETWELL RD BLDG G1
SOUTHAVEN MS
38672-7303
US

IV. Provider business mailing address

5699 GETWELL RD BLDG G1
SOUTHAVEN MS
38672-7303
US

V. Phone/Fax

Practice location:
  • Phone: 662-910-8195
  • Fax: 662-910-8195
Mailing address:
  • Phone: 662-910-8195
  • Fax: 662-910-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3037
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3037
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3037
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: