Healthcare Provider Details

I. General information

NPI: 1437005584
Provider Name (Legal Business Name): KYRA JAYNE KOWALEWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 DES ARC RD
JOHNS ISLAND SC
29455-8334
US

IV. Provider business mailing address

887 JOHNNIE DODDS BLVD
MOUNT PLEASANT SC
29464-3154
US

V. Phone/Fax

Practice location:
  • Phone: 484-746-0483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10808
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: