Provider Demographics
NPI:1508311218
Name:GARCIA-FOWLKES, JODY (CP)
Entity type:Individual
Prefix:DR
First Name:JODY
Middle Name:
Last Name:GARCIA-FOWLKES
Suffix:
Gender:F
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 CHARING CROSS DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1540
Mailing Address - Country:US
Mailing Address - Phone:248-308-6510
Mailing Address - Fax:
Practice Address - Street 1:555 W WACKERLY ST STE 3625
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4715
Practice Address - Country:US
Practice Address - Phone:989-832-4202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016828103TC0700X
MI6351004625103TC2200X, 103TH0004X, 103TC0700X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No101Y00000XBehavioral Health & Social Service ProvidersCounselor