Provider Demographics
NPI:1760737779
Name:KULAKOWSKI, LILAH JUDE (LPT)
Entity Type:Individual
Prefix:
First Name:LILAH
Middle Name:JUDE
Last Name:KULAKOWSKI
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6341 PICCADILLY SQUARE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-5103
Mailing Address - Country:US
Mailing Address - Phone:251-343-5300
Mailing Address - Fax:251-343-6613
Practice Address - Street 1:6341 PICCADILLY SQUARE DR
Practice Address - Street 2:SUITE A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-5103
Practice Address - Country:US
Practice Address - Phone:251-343-5300
Practice Address - Fax:251-343-6613
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1773101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor