Provider Demographics
NPI:1174986061
Name:COURTNEY N WOWK LCSW LLC
Entity type:Organization
Organization Name:COURTNEY N WOWK LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:WOWK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-615-7338
Mailing Address - Street 1:7 OAK HILL TER
Mailing Address - Street 2:SUITE 15
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8996
Mailing Address - Country:US
Mailing Address - Phone:207-615-7338
Mailing Address - Fax:
Practice Address - Street 1:7 OAK HILL TER
Practice Address - Street 2:SUITE 15
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8996
Practice Address - Country:US
Practice Address - Phone:207-615-7338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC129081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty