Healthcare Provider Details

I. General information

NPI: 1013080092
Provider Name (Legal Business Name): DENINE RACHELLE BOWMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 COURTHOUSE SQ SUITE 202
ROCKVILLE MD
20850-2336
US

IV. Provider business mailing address

3809 LAWRENCE AVE
KENSINGTON MD
20895-1534
US

V. Phone/Fax

Practice location:
  • Phone: 301-424-6955
  • Fax:
Mailing address:
  • Phone: 301-949-2788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC1153
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: