Provider Demographics
NPI:1235478355
Name:LOWDERGROUP LLC
Entity Type:Organization
Organization Name:LOWDERGROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MILT
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOWDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:864-239-4110
Mailing Address - Street 1:86 VILLA RD STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3052
Mailing Address - Country:US
Mailing Address - Phone:864-239-4110
Mailing Address - Fax:864-242-9808
Practice Address - Street 1:86 VILLA RD STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3052
Practice Address - Country:US
Practice Address - Phone:864-239-4110
Practice Address - Fax:864-242-9808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1029103TC0700X
SC1194103TC0700X
SC345002084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty