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Provider Information for 1447428693


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Ms. REGINA GERARD KUJAWA LCSW


Sex: Female

NPI: 1447428693
Last Updated: 2024-03-07
Certification Date: 2024-03-07

Details

NameValue
NPI1447428693
Enumeration Date2008-02-11
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address PO BOX 751803
CHARLOTTE, NC 28275-1803
United States

Phone: | Fax:
 
Primary Practice Address 175 KIMEL PARK DR STE 100
WINSTON SALEM, NC 27103-6951
United States

Phone: 336-718-3550 | Fax:336-277-1825
 
Secondary Practice Address(es)

1904 KELLO DR
GREENSBORO, NC 27455
United States

Phone: 336-286-6405 | Fax:
 

Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 104100000X - Social Worker NCC005753
No 104100000X - Social Worker FLSW6677
Yes 1041C0700X - Social Worker - ClinicalNCC005733