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General NPI Number Information
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NPI Number | 1962073544
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Entity Type | Individual
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Provider Name | TEISHA FOWLER LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 07/06/2021
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 2040 RANDOLPH RD
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City | CHARLOTTE
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State | NC
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Zip | 28207-1236
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Country | US
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Telephone | 980-219-8622
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Fax |
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Provider Business Mailing Address
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Address Line | 7008 IDLEWILD BROOK LN
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City | CHARLOTTE
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State | NC
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Zip | 28212-5855
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Country | US
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Telephone | 317-480-9419
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A16734
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License Number State | NC
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