Provider Demographics
NPI:1821574294
Name:JAMES KRZEMIENIECKI, ANNA (LCPC, NCC , MS)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:JAMES KRZEMIENIECKI
Suffix:
Gender:F
Credentials:LCPC, NCC , MS
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:JAMES KRZEMIENIECKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANNA JAMES
Mailing Address - Street 1:1406 N MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1746
Mailing Address - Country:US
Mailing Address - Phone:509-312-9902
Mailing Address - Fax:
Practice Address - Street 1:1504 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1707
Practice Address - Country:US
Practice Address - Phone:509-312-9902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6996101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health