Provider Demographics
NPI:1013193010
Name:KOULIANOS, JOANNA T (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:T
Last Name:KOULIANOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1956 S UNIVERSITY BLVD STE J
Mailing Address - Street 2:PMB 196
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-2928
Mailing Address - Country:US
Mailing Address - Phone:251-654-2429
Mailing Address - Fax:
Practice Address - Street 1:22 N FLORIDA ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3108
Practice Address - Country:US
Practice Address - Phone:251-654-2429
Practice Address - Fax:251-470-0409
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1453103TC0700X, 103TC2200X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist