Individual
GLENN FOWLKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1 MILL ST, #102, FARMVILLE, VA 23901-3401
(434) 298-7318
Mailing address
2114 ORCHARD RD, BURKEVILLE, VA 23922-3524
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701005616
VA
Other
Enumeration date
08/22/2014
Last updated
08/22/2014
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