Provider Demographics
NPI:1598073827
Name:FOWLES, KRISTIN C (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:C
Last Name:FOWLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MICHAEL TOWNSEND CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-1140
Mailing Address - Country:US
Mailing Address - Phone:801-824-6037
Mailing Address - Fax:302-368-1662
Practice Address - Street 1:11 MICHAEL TOWNSEND CT
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-1140
Practice Address - Country:US
Practice Address - Phone:801-824-6037
Practice Address - Fax:302-368-1662
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE20106008311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical