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NPI Code Detail

MEDICARE: STACY BOWMAN

MEDICARE: STACY BOWMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285085506
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY BOWMAN
Provider Business Mailing Address
First Line : 2100 CHARLIE HALL BLVD
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-5832
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 115 FAIRCHILD ST STE 170
Second Line :
City : DANIEL ISLAND
State : SC
Zip : 29492-7602
Country : US
Telephone Number : 803-339-1563
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2016
Last Update Date : 03/27/2025

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Directions to “ STACY BOWMAN ” Practice Location

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