Provider Demographics
NPI:1861417099
Name:COWART, PEARL (MSW)
Entity type:Individual
Prefix:
First Name:PEARL
Middle Name:
Last Name:COWART
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 1:35805 MARGARET APT 19 304
Mailing Address - Street 2:
Mailing Address - City:ROMULAS
Mailing Address - State:MI
Mailing Address - Zip Code:48174
Mailing Address - Country:US
Mailing Address - Phone:248-559-1763
Mailing Address - Fax:
Practice Address - Street 1:35605 MARGARET APT 19 304
Practice Address - Street 2:
Practice Address - City:ROMULAS
Practice Address - State:MI
Practice Address - Zip Code:48174
Practice Address - Country:US
Practice Address - Phone:248-559-1763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802071959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6802071959OtherSTATE LIC