Healthcare Provider Details

I. General information

NPI: 1073669370
Provider Name (Legal Business Name): SHARON G. FOWLER LPC, LPCS, CTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 CLEMSON BLVD SUITE 1 C
ANDERSON SC
29621-1100
US

IV. Provider business mailing address

4122 CLEMSON BLVD SUITE 1 C
ANDERSON SC
29621-1100
US

V. Phone/Fax

Practice location:
  • Phone: 864-225-3560
  • Fax: 864-225-3560
Mailing address:
  • Phone: 864-225-3560
  • Fax: 864-225-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1545
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3007
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: