Provider Demographics
NPI:1891860987
Name:OWENS, CONNIE E (LMSW, LCSW)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:E
Last Name:OWENS
Suffix:
Gender:F
Credentials:LMSW, LCSW
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:E
Other - Last Name:NIKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9714 MAGNOLIA VIEW CT APT 206
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-4641
Mailing Address - Country:US
Mailing Address - Phone:810-990-5020
Mailing Address - Fax:
Practice Address - Street 1:9714 MAGNOLIA VIEW CT APT 206
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-4641
Practice Address - Country:US
Practice Address - Phone:810-990-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010913511041C0700X
FLSW163851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical