Provider Demographics
NPI:1962827410
Name:KOWAL, COLLEEN SUZANNE (MED, LPC-I)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:SUZANNE
Last Name:KOWAL
Suffix:
Gender:F
Credentials:MED, LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 GRAHAM LN
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1475
Mailing Address - Country:US
Mailing Address - Phone:843-683-2655
Mailing Address - Fax:
Practice Address - Street 1:1536 FORDING ISLAND RD
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-1120
Practice Address - Country:US
Practice Address - Phone:843-683-2655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5841101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional