Provider Demographics
NPI:1336539006
Name:CAROL FOWLER LLC
Entity Type:Organization
Organization Name:CAROL FOWLER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLIICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:479-220-9694
Mailing Address - Street 1:3211 SW BRIAR CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7995
Mailing Address - Country:US
Mailing Address - Phone:479-220-9694
Mailing Address - Fax:
Practice Address - Street 1:3211 SW BRIAR CREEK AVE
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7995
Practice Address - Country:US
Practice Address - Phone:479-220-9694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1594-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty