Individual
MS. KANDI M FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC,MISA1,CAMS11
Contact information
Practice address
721 N. LASALLE ST., 2601 W. MARQUETTE RD, CHICAGO, IL 60629
(773) 349-8050
(773) 349-8080
Mailing address
721 N. LASALLE, 721 N. LASALLE, CHICAGO, IL 60654
(773) 349-8050
(773) 349-8080
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
25385
IL
101YM0800X
Mental Health Counselor
25385
IL
Other
Enumeration date
08/28/2016
Last updated
08/28/2016
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