Provider Demographics
NPI:1265701643
Name:LOWE, MARLO D
Entity type:Individual
Prefix:
First Name:MARLO
Middle Name:D
Last Name:LOWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9410 VANDERBILT DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-4358
Mailing Address - Country:US
Mailing Address - Phone:501-223-2413
Mailing Address - Fax:
Practice Address - Street 1:628 W BROADWAY ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-5544
Practice Address - Country:US
Practice Address - Phone:501-372-4242
Practice Address - Fax:501-372-4758
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR189960740Medicaid