Doctor Name: | DOROTHY BENSON MCGOWN |
NPI Number: | 1225021744 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | SW4462 |
Business Practice Address: | 1333b Atlantic Ave Fernandina Beach, FL - 320343247 |
Business Phone Number: | 9044911999 |
Business Fax Number: | 9044913399 |
Mailing Address: | 4929 Spanish Oaks Cir, FERNANDINA BEACH |
State: | FL |
Postal Code: | 320345679 |
Phone Number: | 9044911999 |
Fax Number: | 9044913399 |
NPI Enumeration Date: | 08/30/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | SW4462 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |