Provider Demographics
NPI:1750046645
Name:PODWOSKI, KARI L
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:L
Last Name:PODWOSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5699 GETWELL RD BLDG G1
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-7303
Mailing Address - Country:US
Mailing Address - Phone:662-910-8195
Mailing Address - Fax:662-910-8195
Practice Address - Street 1:5699 GETWELL RD BLDG G1
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-7303
Practice Address - Country:US
Practice Address - Phone:662-910-8195
Practice Address - Fax:662-910-8195
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional