Provider Demographics
NPI:1275596710
Name:SOWERS, THERESA ELAINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ELAINE
Last Name:SOWERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TERRI
Other - Middle Name:ELAINE
Other - Last Name:SOWERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1970 ROANOKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-6404
Mailing Address - Country:US
Mailing Address - Phone:540-982-2463
Mailing Address - Fax:540-855-3447
Practice Address - Street 1:1970 ROANOKE BLVD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-6404
Practice Address - Country:US
Practice Address - Phone:540-982-2463
Practice Address - Fax:540-855-3447
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040066121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical