Provider Demographics
NPI:1487836300
Name:FOWLER, BOBBY E (MA)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:E
Last Name:FOWLER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 FINAL LANDING LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9259
Mailing Address - Country:US
Mailing Address - Phone:910-520-0225
Mailing Address - Fax:
Practice Address - Street 1:1310 FINAL LANDING LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9259
Practice Address - Country:US
Practice Address - Phone:910-520-0225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4836101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional