Provider Demographics
NPI:1275655896
Name:ZAWACKI, CAROL (LMSW, SAP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:ZAWACKI
Suffix:
Gender:F
Credentials:LMSW, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 E MUNGER RD
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-8736
Mailing Address - Country:US
Mailing Address - Phone:517-787-7920
Mailing Address - Fax:517-787-2440
Practice Address - Street 1:142 E MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2735
Practice Address - Country:US
Practice Address - Phone:517-263-2625
Practice Address - Fax:517-263-7369
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health