Healthcare Provider Details

I. General information

NPI: 1962827410
Provider Name (Legal Business Name): COLLEEN SUZANNE KOWAL M.ED., LPC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 FORDING ISLAND RD
HILTON HEAD ISLAND SC
29926-1120
US

IV. Provider business mailing address

32 GRAHAM LN
HILTON HEAD ISLAND SC
29926-1475
US

V. Phone/Fax

Practice location:
  • Phone: 843-683-2655
  • Fax:
Mailing address:
  • Phone: 843-683-2655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5841
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: