Provider Demographics
NPI:1740047281
Name:FOWLER, STASHA (MSW)
Entity type:Individual
Prefix:
First Name:STASHA
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 WINDY HILL RD SE STE 300
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8621
Mailing Address - Country:US
Mailing Address - Phone:678-561-5066
Mailing Address - Fax:
Practice Address - Street 1:2470 WINDY HILL RD SE STE 300
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8621
Practice Address - Country:US
Practice Address - Phone:678-561-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor