Provider Demographics
NPI:1912302092
Name:FOWLER, ALICIA NICOLE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:NICOLE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 E OREGON RD
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1331
Mailing Address - Country:US
Mailing Address - Phone:810-956-2325
Mailing Address - Fax:
Practice Address - Street 1:1320 E OREGON RD
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1331
Practice Address - Country:US
Practice Address - Phone:810-956-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010974291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical