Provider Demographics
NPI:1538774344
Name:OWEN, JAMES CONALLY (MSW, LISW-CP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CONALLY
Last Name:OWEN
Suffix:
Gender:M
Credentials:MSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7124 ARBOR OAKS DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-4740
Mailing Address - Country:US
Mailing Address - Phone:757-642-3760
Mailing Address - Fax:
Practice Address - Street 1:3001 WRIGHTSVILLE AVE STE B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4106
Practice Address - Country:US
Practice Address - Phone:910-769-6360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC127211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical