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1487162962
THEODORE WILLIAM FOWLER
SAN JOSE, CA
NPI
1487162962
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA R1208500715)
Enumeration Date
2018-01-18
Last Update Date
2018-01-18
Business Address
THEODORE WILLIAM FOWLER
650 S BASCOM AVE
SAN JOSE, CA 95128-2601
Phone number: 408-283-8555
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Mailing Address
THEODORE WILLIAM FOWLER
650 S BASCOM AVE
SAN JOSE, CA 95128-2601
Phone number: 408-283-8555
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