Individual
CHASITY SHANELL FOWLKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC, CAP
Contact information
Practice address
2814 S US HIGHWAY 1, SUITE D4, FORT PIERCE, FL 34982-8120
(863) 669-8910
Mailing address
11582 SW VILLAGE PKWY # 1137, PORT SAINT LUCIE, FL 34987-2392
(772) 208-7834
(772) 607-5295
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
MH12547
FL
Other
Enumeration date
07/18/2012
Last updated
06/08/2023
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