Individual
JOHN R. FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW-CP, CADC-III
Contact information
Practice address
203 BEATY STREET, COWNAY, SC 29526
(843) 248-9216
(843) 248-4013
Mailing address
P O BOX 30819, MYRTLE BEACH, SC 29588-0014
(843) 248-9216
(843) 248-4013
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
721
WI
1041C0700X
Clinical Social Worker
2307
SC
Other
Enumeration date
12/05/2006
Last updated
01/08/2008
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