Provider Demographics
NPI:1801405410
Name:FOWLER, MANDI (LICSW)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14669 BEL AIRE EST
Mailing Address - Street 2:
Mailing Address - City:COKER
Mailing Address - State:AL
Mailing Address - Zip Code:35452-3517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14669 BEL AIRE EST
Practice Address - Street 2:
Practice Address - City:COKER
Practice Address - State:AL
Practice Address - Zip Code:35452-3517
Practice Address - Country:US
Practice Address - Phone:205-310-4822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2297C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical