Provider Demographics
NPI:1184030546
Name:DOWD, MARY JEAN (LCAS-A)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JEAN
Last Name:DOWD
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:JEAN
Other - Last Name:DOWD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAS-A
Mailing Address - Street 1:2520 TROY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7661
Mailing Address - Country:US
Mailing Address - Phone:910-762-2727
Mailing Address - Fax:910-762-7923
Practice Address - Street 1:2520 TROY DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7661
Practice Address - Country:US
Practice Address - Phone:910-762-2727
Practice Address - Fax:910-762-7823
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20185101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)