Provider Demographics
NPI:1467625616
Name:FOWLER, JAMES MICHAEL (MS, LPC, NCC, BCPCC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:FOWLER
Suffix:
Gender:M
Credentials:MS, LPC, NCC, BCPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 PROMINENCE CT
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-8953
Mailing Address - Country:US
Mailing Address - Phone:706-216-4735
Mailing Address - Fax:706-216-7909
Practice Address - Street 1:137 PROMINENCE CT
Practice Address - Street 2:SUITE 220
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-8953
Practice Address - Country:US
Practice Address - Phone:706-216-4735
Practice Address - Fax:706-216-7909
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004310101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA406922506AMedicaid