Provider Demographics
NPI:1265040927
Name:GOWER, JULIE A (LSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:GOWER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17548 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-9797
Mailing Address - Country:US
Mailing Address - Phone:304-441-2001
Mailing Address - Fax:304-441-2009
Practice Address - Street 1:17548 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-9797
Practice Address - Country:US
Practice Address - Phone:304-441-2001
Practice Address - Fax:304-441-2009
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00938990174H00000X, 405300000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No174H00000XOther Service ProvidersHealth Educator
No405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVAP00938990OtherWV BOARD OF SOCIAL WORK