MEDICARE: PETER F FOWLE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	6693	KS
2	1041C0700X	Clinical Social Worker	C008736	NC

General Provider Information

NPI Number	:	1780874032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER F FOWLE LCSW

Provider Business Mailing Address
First Line	:	10130 PERIMETER PKWY
Second Line	:	STE 200
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-2447
Country	:	US
Telephone Number	:	888-849-7379
Fax Number	:	855-857-7333

Provider Business Practice Location Address
First Line	:	10130 PERIMETER PKWY
Second Line	:	STE 200
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-2447
Country	:	US
Telephone Number	:	888-849-7379
Fax Number	:	855-857-7333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	02/10/2017

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Directions to “ PETER F FOWLE LCSW” Practice Location

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