Healthcare Provider Details

I. General information

NPI: 1972416113
Provider Name (Legal Business Name): MRS. CHARNEA LASHAE FOWLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ELLA AVE
JOLIET IL
60433-2700
US

IV. Provider business mailing address

501 ELLA AVE
JOLIET IL
60433-2700
US

V. Phone/Fax

Practice location:
  • Phone: 815-582-2685
  • Fax: 815-846-0668
Mailing address:
  • Phone: 815-582-2685
  • Fax: 815-846-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: