Provider Demographics
NPI:1255563904
Name:STOWE, DEMETRIA KRISTEN (BS)
Entity type:Individual
Prefix:MRS
First Name:DEMETRIA
Middle Name:KRISTEN
Last Name:STOWE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:521 ROTARY HILLS CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-3905
Mailing Address - Country:US
Mailing Address - Phone:931-237-8694
Mailing Address - Fax:
Practice Address - Street 1:118 UNION ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5115
Practice Address - Country:US
Practice Address - Phone:931-647-8257
Practice Address - Fax:931-647-2978
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness