| NPI | 1598250359 |
|---|---|
| Former Name | PATRICIA LYNN FOWLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN 1210) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2018-06-25 |