Individual
DR. THERESA MARIE NOWAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
233 LARCH LN, LEXINGTON, KY 40511-2006
(859) 351-6471
Mailing address
233 LARCH LN, LEXINGTON, KY 40511-2006
(859) 351-6471
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
128999
KY
103TC2200X
Clinical Child & Adolescent Psychologist
128999
KY
103TS0200X
School Psychologist
128999
KY
Other
Enumeration date
06/11/2020
Last updated
06/11/2020
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