Individual
BLAKE ANTHONY FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APC, NCC
Contact information
Practice address
175 GWINNET DRIVE, LAWRENCEVILLE, GA 30046
(678) 209-2394
Mailing address
337 OSPREY POINT, STONE MOUNTAIN, GA 30087
(470) 286-5985
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
APC009118
GA
Other
Enumeration date
06/26/2023
Last updated
06/26/2023
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