Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 1453 | AL |
N | 103TC0700X | Clinical Psychologist | 1453 | AL |
Y | 103G00000X | Clinical Psychologist | 1453 | AL |
Y | 103TC0700X | Clinical Psychologist | 1453 | AL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 1453 | AL |
NPI | 1013193010 |
---|---|
Provider Name | Dr. Joanna T Koulianos |
First Address | Mobile, AL 36609-2928 |
Second Address | Mobile, AL 36607-3108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2008 |
Last Update Date | 05/09/2013 |