Provider Demographics
NPI:1467492827
Name:ROWAN, CAROL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:ROWAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854 LAUREL MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-1815
Mailing Address - Country:US
Mailing Address - Phone:540-389-4126
Mailing Address - Fax:276-601-8981
Practice Address - Street 1:1854 LAUREL MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-1815
Practice Address - Country:US
Practice Address - Phone:540-389-4126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2009-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001598103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00684161OtherRAILROAD MEDICARE
VA362621OtherANTHEM BLUE CROSS BLUE SHIELD
VA1467492827Medicaid
VA190002056Medicare PIN