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1518369065
DERRICK FOWLER
WINSTON SALEM, NC
NPI
1518369065
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: NC LCAS-16)
Enumeration Date
2014-09-16
Last Update Date
2019-07-31
Business Address
DERRICK FOWLER LCAS-A
650 HIGHLAND AVE STE 100
WINSTON SALEM, NC 27101-4304
Phone number: 336-607-8523
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Mailing Address
DERRICK FOWLER LCAS-A
868 NEAL RD
REIDSVILLE, NC 27320-0336
Phone number: 336-524-1811
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