Individual
KEN-NETTA FOWLKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA ,MA
Contact information
Practice address
103 RODGERS PL, NORTH VERSAILLES, PA 15137-1610
(412) 401-1476
Mailing address
103 RODGERS PL, NORTH VERSAILLES, PA 15137-1610
(412) 824-6548
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
172V00000X
Community Health Worker
—
—
Other
Enumeration date
07/17/2012
Last updated
09/15/2015
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