Provider Demographics
NPI:1669769014
Name:LOWDERMILK, BEVERLY BOOTH (LCSW)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:BOOTH
Last Name:LOWDERMILK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:BOOTH
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:316 COLLEGE ST E
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-3006
Mailing Address - Country:US
Mailing Address - Phone:931-227-8031
Mailing Address - Fax:931-438-0727
Practice Address - Street 1:704 MAPLE ST W
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3202
Practice Address - Country:US
Practice Address - Phone:931-438-3233
Practice Address - Fax:931-438-0727
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical