Provider Demographics
NPI:1316377468
Name:FOWLKES, TALITHA ANDERSON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TALITHA
Middle Name:ANDERSON
Last Name:FOWLKES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1824
Mailing Address - Country:US
Mailing Address - Phone:859-239-5870
Mailing Address - Fax:859-239-5879
Practice Address - Street 1:222 S 3RD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1824
Practice Address - Country:US
Practice Address - Phone:859-239-5870
Practice Address - Fax:859-239-5879
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38111041C0700X
VA09040068961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical