Provider Demographics
NPI:1598184301
Name:SOWE, KOFFI JAMIL (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:KOFFI
Middle Name:JAMIL
Last Name:SOWE
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10079 STEDWICK RD
Mailing Address - Street 2:2975
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-9997
Mailing Address - Country:US
Mailing Address - Phone:240-779-6633
Mailing Address - Fax:
Practice Address - Street 1:22880 WHELAN LANE
Practice Address - Street 2:
Practice Address - City:BOYDS
Practice Address - State:MD
Practice Address - Zip Code:20841
Practice Address - Country:US
Practice Address - Phone:240-779-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD079081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical