Provider Demographics
NPI:1740358498
Name:MOWRY, PATRICIA H (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:H
Last Name:MOWRY
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BRADFORD SQ
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-1941
Mailing Address - Country:US
Mailing Address - Phone:678-357-7510
Mailing Address - Fax:678-868-2354
Practice Address - Street 1:135 BRADFORD SQ
Practice Address - Street 2:SUITE B
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-1941
Practice Address - Country:US
Practice Address - Phone:678-357-7510
Practice Address - Fax:678-868-2354
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002942101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional