Most Relevant Information
Provider Data
| NPI Number: | 1003486465 |
| Provider Name: | KRYSTLE KRYSTALIA KOUGIAS LAC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/29/2021 |
| Last Updated: | 08/02/2021 |
Provider Practice Location
304 NEWTON AVE
OAKLYN
NJ
081071446
Practice Location Phone/Fax
| Phone: | 6095439752 |
| Fax: |
Provider Mailing Location
304 NEWTON AVE
OAKLYN
NJ
081071446
Provider Mailing Phone/Fax
| Phone: | 6095439752 |
| Fax: |