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Individual

SHYTIERA FOWLKES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1119 E MONUMENT ST, BALTIMORE, MD 21202-4119
(443) 708-3823
Mailing address
3310 EASTERN AVE, BALTIMORE, MD 21224-4108
(443) 708-5056

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
106S00000X
Behavior Technician

Other

Enumeration date
11/14/2018
Last updated
10/08/2024
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