Individual
MARY LESLIE WILSON FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1800 HILL DR STE E, GRENADA, MS 38901-5071
(662) 582-3193
Mailing address
403 COLLEGE ST, WINONA, MS 38967-1832
(662) 582-3193
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1157
MS
Other
Enumeration date
10/01/2008
Last updated
10/01/2008
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