Provider Demographics
NPI:1649641705
Name:JOWERS, LINDA SUE (LCSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:JOWERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:JOWERS
Other - Last Name:LEASE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1101 PROSPECT PROMENADE
Mailing Address - Street 2:UNIT 402
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-1476
Mailing Address - Country:US
Mailing Address - Phone:850-867-5933
Mailing Address - Fax:850-249-4025
Practice Address - Street 1:1101 PROSPECT PROMENADE
Practice Address - Street 2:UNIT 402
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-1476
Practice Address - Country:US
Practice Address - Phone:850-867-5933
Practice Address - Fax:850-249-4025
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW3997101YM0800X
SC10968101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health