Provider Demographics
NPI:1073114138
Name:ROWAN, THOMAS (CAC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:ROWAN
Suffix:
Gender:M
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 HUTCHINSON ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-4805
Mailing Address - Country:US
Mailing Address - Phone:998-502-7336
Mailing Address - Fax:877-361-1631
Practice Address - Street 1:63069 HUMMINGBIRD LN
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-7306
Practice Address - Country:US
Practice Address - Phone:985-626-0063
Practice Address - Fax:877-361-1631
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1484101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)