Provider Demographics
NPI:1760134316
Name:REGINA KUJAWA LCSW PLLC
Entity Type:Organization
Organization Name:REGINA KUJAWA LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUJAWA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:336-554-3291
Mailing Address - Street 1:5603B W FRIENDLY AVE # 256
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4213
Mailing Address - Country:US
Mailing Address - Phone:336-554-3291
Mailing Address - Fax:
Practice Address - Street 1:1175 REVOLUTION MILL DR STE 29-2
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5079
Practice Address - Country:US
Practice Address - Phone:336-554-3291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty