Healthcare Provider Details

I. General information

NPI: 1689109258
Provider Name (Legal Business Name): KRISTIN KOWALSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42009 VICTORY LN
LEESBURG VA
20176-6269
US

IV. Provider business mailing address

157 ALPINE DR SE
LEESBURG VA
20175-6167
US

V. Phone/Fax

Practice location:
  • Phone: 703-777-0800
  • Fax:
Mailing address:
  • Phone: 703-216-8576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904009845
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: