Healthcare Provider Details

I. General information

NPI: 1316540651
Provider Name (Legal Business Name): SEANA PERNICE KOWALCZYK LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 HORIZON TRL
ABERDEEN NC
28315-7423
US

IV. Provider business mailing address

180 HORIZON TRL
ABERDEEN NC
28315-7423
US

V. Phone/Fax

Practice location:
  • Phone: 910-603-1856
  • Fax:
Mailing address:
  • Phone: 910-603-1856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14218
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: