Healthcare Provider Details

I. General information

NPI: 1609365097
Provider Name (Legal Business Name): BOWEN PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5599 FISH HAWK CT
WALDORF MD
20601-4543
US

IV. Provider business mailing address

150 POST OFFICE RD UNIT 827
WALDORF MD
20604-7533
US

V. Phone/Fax

Practice location:
  • Phone: 301-448-0818
  • Fax:
Mailing address:
  • Phone: 301-448-0818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DESNEY BOWEN
Title or Position: OWNER/PRESIDENT
Credential: LCPC
Phone: 301-448-0818