Provider Demographics
NPI:1093201790
Name:CALLOWAY, LOWANTHA (CPSS)
Entity Type:Individual
Prefix:
First Name:LOWANTHA
Middle Name:
Last Name:CALLOWAY
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17950 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-2260
Mailing Address - Country:US
Mailing Address - Phone:313-733-1300
Mailing Address - Fax:313-826-0452
Practice Address - Street 1:17950 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-2260
Practice Address - Country:US
Practice Address - Phone:313-733-1300
Practice Address - Fax:313-826-0452
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist