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General NPI Number Information
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NPI Number | 1669769014
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Entity Type | Individual
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Provider Name | BEVERLY BOOTH LOWDERMILK LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/06/2011
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 704 MAPLE ST W
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-3202
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Country | US
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Telephone | 931-438-3233
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Fax | 931-438-0727
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Provider Business Mailing Address
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Address Line | 316 COLLEGE ST E
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-3006
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Country | US
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Telephone | 931-227-8031
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Fax | 931-438-0727
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4215
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License Number State | TN
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