Provider Demographics
NPI:1013512367
Name:KOZAK, DAVID (MSW, LCSW-A)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KOZAK
Suffix:
Gender:M
Credentials:MSW, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 LOUISIANA DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-6017
Mailing Address - Country:US
Mailing Address - Phone:910-585-9047
Mailing Address - Fax:
Practice Address - Street 1:203 N MAIN ST STE 216
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5343
Practice Address - Country:US
Practice Address - Phone:336-322-0657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0145281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical