Provider Demographics
NPI:1427420629
Name:MCGOWAN, KENNETH R (LPC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:R
Last Name:MCGOWAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 DIXIE ST STE 4
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3870
Mailing Address - Country:US
Mailing Address - Phone:770-834-8327
Mailing Address - Fax:770-834-7271
Practice Address - Street 1:523 DIXIE ST STE 4
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3870
Practice Address - Country:US
Practice Address - Phone:770-834-8327
Practice Address - Fax:770-834-7271
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000494101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional