Provider Demographics
NPI:1841052396
Name:KOZLOWSKI, MARY ALESHA
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ALESHA
Last Name:KOZLOWSKI
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 1:6009 MONTICELLO DR STE C
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-6209
Mailing Address - Country:US
Mailing Address - Phone:334-697-3590
Mailing Address - Fax:
Practice Address - Street 1:6009 MONTICELLO DR STE C
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-6209
Practice Address - Country:US
Practice Address - Phone:334-697-3590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health