Provider Demographics
NPI:1558807628
Name:FOWLER, COURTNEY KAY (CADCII)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:KAY
Last Name:FOWLER
Suffix:
Gender:F
Credentials:CADCII
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:KAY
Other - Last Name:TABB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADCII
Mailing Address - Street 1:607 RUSSELL PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7690
Mailing Address - Country:US
Mailing Address - Phone:478-225-9060
Mailing Address - Fax:478-225-9861
Practice Address - Street 1:607 RUSSELL PKWY STE A
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7690
Practice Address - Country:US
Practice Address - Phone:478-225-9060
Practice Address - Fax:478-225-9861
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA604101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)