Healthcare Provider Details

I. General information

NPI: 1417084054
Provider Name (Legal Business Name): KAREN S. FOWLKES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9228 GEORGE WASHINGTON MEMORIAL HWY
GLOUCESTER VA
23061-4162
US

IV. Provider business mailing address

9228 GEORGE WASHINGTON MEMORIAL HWY
GLOUCESTER VA
23061-4162
US

V. Phone/Fax

Practice location:
  • Phone: 804-693-5057
  • Fax: 804-693-7407
Mailing address:
  • Phone: 804-693-5057
  • Fax: 804-693-7407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701001946
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: