Provider Demographics
NPI:1063294957
Name:OWENS, KADISON (LPC, CRC, NCC)
Entity type:Individual
Prefix:
First Name:KADISON
Middle Name:
Last Name:OWENS
Suffix:
Gender:
Credentials:LPC, CRC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 E GRAND AVE
Mailing Address - Street 2:PMB 149
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-3839
Mailing Address - Country:US
Mailing Address - Phone:074-215-3203
Mailing Address - Fax:
Practice Address - Street 1:1257 COMMERCIAL DR SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5991
Practice Address - Country:US
Practice Address - Phone:770-285-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-2407101YM0800X
GA101Y00000X, 225C00000X
GALPC013899101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor