Provider Demographics
NPI:1235711441
Name:SOWELL, TONDRA L (MA)
Entity Type:Individual
Prefix:
First Name:TONDRA
Middle Name:L
Last Name:SOWELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 WHITE PLAINS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29718-7804
Mailing Address - Country:US
Mailing Address - Phone:843-622-5768
Mailing Address - Fax:
Practice Address - Street 1:125 E PLAZA DR STE 118
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-8087
Practice Address - Country:US
Practice Address - Phone:980-210-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health