Provider Demographics
NPI:1710350673
Name:MCCOWN, AMINA
Entity Type:Individual
Prefix:
First Name:AMINA
Middle Name:
Last Name:MCCOWN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMINA
Other - Middle Name:
Other - Last Name:MCCOWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:21 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-3401
Mailing Address - Country:US
Mailing Address - Phone:267-401-9652
Mailing Address - Fax:
Practice Address - Street 1:21 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-3401
Practice Address - Country:US
Practice Address - Phone:267-401-9652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-01
Last Update Date:2015-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008507101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional