Provider Demographics
NPI:1922253764
Name:MCGOWAN, HENRIETTA CATHERINE (LMHC,LPC, CAP, NCC)
Entity Type:Individual
Prefix:DR
First Name:HENRIETTA
Middle Name:CATHERINE
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:LMHC,LPC, CAP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4843
Mailing Address - Country:US
Mailing Address - Phone:904-556-6829
Mailing Address - Fax:202-330-4600
Practice Address - Street 1:405 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4843
Practice Address - Country:US
Practice Address - Phone:904-556-6829
Practice Address - Fax:202-330-4600
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7983101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health