Provider Demographics
NPI:1285223289
Name:STOWE, LATRICE LAWANDA (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LATRICE
Middle Name:LAWANDA
Last Name:STOWE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 REVERE DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8926
Mailing Address - Country:US
Mailing Address - Phone:718-696-7849
Mailing Address - Fax:
Practice Address - Street 1:8040 REVERE DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-8926
Practice Address - Country:US
Practice Address - Phone:718-696-7849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0074001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty