Doctor Name: | LOWA GWEN JOHNSON |
NPI Number: | 1184998932 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | LC4339 |
Business Practice Address: | 626 Revolution St Havre De Grace, MD - 210783320 |
Business Phone Number: | 4433503817 |
Business Fax Number: | |
Mailing Address: | 626 Revolution St, HAVRE DE GRACE |
State: | MD |
Postal Code: | 210783320 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 02/25/2012 |
NPI Last Update Date: | 02/25/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LC4339 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |