Provider Demographics
NPI:1194095067
Name:KOZLOWSKI, NANCY LASITER (LPC)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LASITER
Last Name:KOZLOWSKI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BREEDS HILL CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2514
Mailing Address - Country:US
Mailing Address - Phone:501-352-2791
Mailing Address - Fax:
Practice Address - Street 1:11 BREEDS HILL CT
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2514
Practice Address - Country:US
Practice Address - Phone:501-352-2791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0212047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional