Provider Demographics
NPI:1083402267
Name:FOWLIN, OLISA KARIMA (LMHC)
Entity type:Individual
Prefix:MS
First Name:OLISA
Middle Name:KARIMA
Last Name:FOWLIN
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-6935
Mailing Address - Country:US
Mailing Address - Phone:646-395-4402
Mailing Address - Fax:
Practice Address - Street 1:25 AVENUE D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-6935
Practice Address - Country:US
Practice Address - Phone:646-395-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015997-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health