Healthcare Provider Details

I. General information

NPI: 1114431947
Provider Name (Legal Business Name): THOMAS J SOWERS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 748465
ATLANTA GA
30374-8465
US

IV. Provider business mailing address

261 BUCKCAMP LN
MCCALL ID
83638-5092
US

V. Phone/Fax

Practice location:
  • Phone: 855-284-7483
  • Fax: 617-807-0958
Mailing address:
  • Phone: 208-849-3079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-41171
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: