Provider Demographics
NPI:1942950423
Name:LOWCOUNTRY BEHAVIORAL PEDIATRICS, LLC
Entity Type:Organization
Organization Name:LOWCOUNTRY BEHAVIORAL PEDIATRICS, LLC
Other - Org Name:LOWCOUNTRY BEHAVIORAL PEDIATRICS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:509-680-0093
Mailing Address - Street 1:939 COTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3501
Mailing Address - Country:US
Mailing Address - Phone:509-680-0093
Mailing Address - Fax:
Practice Address - Street 1:1525 SAM RITTENBERG BLVD STE 103
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4139
Practice Address - Country:US
Practice Address - Phone:509-680-0093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty