Provider Demographics
NPI:1336785104
Name:LOWERY, CHANNEL
Entity Type:Individual
Prefix:
First Name:CHANNEL
Middle Name:
Last Name:LOWERY
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 1:1 SOUTH GEORGE STREET
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17551-1340
Mailing Address - Country:US
Mailing Address - Phone:484-681-3450
Mailing Address - Fax:
Practice Address - Street 1:1 SOUTH GEORGE STREET
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17551-1340
Practice Address - Country:US
Practice Address - Phone:484-681-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool