MEDICARE: MIRANDA LINDSEY FOWLER MS, LAPC

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	101YM0800X	Mental Health Counselor	APC010810	GA

General Provider Information

NPI Number	:	1942151345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA LINDSEY FOWLER MS, LAPC

Provider Business Mailing Address
First Line	:	3103 ALBERTA DR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-1516
Country	:	US
Telephone Number	:	404-981-6073
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 WATER PL SE STE 250
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-2287
Country	:	US
Telephone Number	:	404-981-6073
Fax Number	:

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

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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