Provider Demographics
NPI:1710560024
Name:JAWORSKI, KATHERINE ALICE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ALICE
Last Name:JAWORSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4766 SUNSET BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9252
Mailing Address - Country:US
Mailing Address - Phone:803-381-5637
Mailing Address - Fax:803-753-0041
Practice Address - Street 1:4766 SUNSET BLVD STE A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9252
Practice Address - Country:US
Practice Address - Phone:803-381-5637
Practice Address - Fax:803-753-0041
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6611101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional