Provider Demographics
NPI:1982002127
Name:KEWAK, KAREN TERESE (LPCA, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:TERESE
Last Name:KEWAK
Suffix:
Gender:F
Credentials:LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 COPPER TREE LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-9967
Mailing Address - Country:US
Mailing Address - Phone:216-533-6920
Mailing Address - Fax:
Practice Address - Street 1:708 COPPER TREE LN
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-9967
Practice Address - Country:US
Practice Address - Phone:216-533-6920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10509101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health