Provider Demographics
NPI:1164833729
Name:FOWLER, SARAH D (LCPC-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:D
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 BROADTURN RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8487
Mailing Address - Country:US
Mailing Address - Phone:207-329-8009
Mailing Address - Fax:
Practice Address - Street 1:144 US ROUTE 1
Practice Address - Street 2:SUITE 4
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7219
Practice Address - Country:US
Practice Address - Phone:207-329-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4307101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional