=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437005584
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYRA JAYNE KOWALEWSKI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2026
-----------------------------------------------------
Last Update Date | 03/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2245 DES ARC RD
-----------------------------------------------------
City | JOHNS ISLAND
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29455-8334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-746-0483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 887 JOHNNIE DODDS BLVD
-----------------------------------------------------
City | MOUNT PLEASANT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29464-3154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 10808
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------