Provider Information for 1831690593
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Mrs. LATOSHA R FOWLKES LCSW
Other Names:Former Name:Ms. LATOSHA R DAVIS LCSWSex: Female
NPI: 1831690593
Last Updated: 2025-01-02
Certification Date: 2025-01-02
Certification Date: 2025-01-02
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1831690593 | ||||||||||||
| Enumeration Date | 2018-02-27 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1260 LYNFIELD PL SAINT LOUIS, MO 63147-1516 United States Phone: 314-565-6822 | Fax: | ||||||||||||
| Primary Practice Address | 1260 LYNFIELD PL SAINT LOUIS, MO 63147-1516 United States Phone: 314-565-6822 | Fax: | ||||||||||||
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