Provider Demographics
NPI:1689005167
Name:KAWULOK, KRIS (MA, NCC, LPCA)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:KAWULOK
Suffix:
Gender:M
Credentials:MA, NCC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-9086
Mailing Address - Country:US
Mailing Address - Phone:704-579-0690
Mailing Address - Fax:
Practice Address - Street 1:9816 SAM FURR RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4946
Practice Address - Country:US
Practice Address - Phone:704-464-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPCA9858101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health