Provider Demographics
NPI:1245440403
Name:FOWLER, CAROL (LCSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 SW BRIAR CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-7995
Mailing Address - Country:US
Mailing Address - Phone:479-220-9694
Mailing Address - Fax:
Practice Address - Street 1:3211 SW BRIAR CREEK AVE
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72713-7995
Practice Address - Country:US
Practice Address - Phone:479-220-9694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001744111041C0700X
AR1594-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical