Provider Demographics
NPI:1467872630
Name:FOWLER, KEYA WILLIAMS (MA)
Entity Type:Individual
Prefix:MRS
First Name:KEYA
Middle Name:WILLIAMS
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-1524
Mailing Address - Country:US
Mailing Address - Phone:803-796-6179
Mailing Address - Fax:866-372-1501
Practice Address - Street 1:2105 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-1524
Practice Address - Country:US
Practice Address - Phone:803-796-6179
Practice Address - Fax:866-372-1501
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC570362584101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health