Provider Demographics
NPI:1114467495
Name:MCGOWAN, CARLA DENISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:DENISE
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 BIENVILLE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-2540
Mailing Address - Country:US
Mailing Address - Phone:601-946-3256
Mailing Address - Fax:
Practice Address - Street 1:3048 BIENVILLE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-2540
Practice Address - Country:US
Practice Address - Phone:601-946-3256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC55231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical