Healthcare Provider Details

I. General information

NPI: 1265202584
Provider Name (Legal Business Name): DIANA J. BOWEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 NECK RD 421 NECK ROAD
SOUTH CHINA ME
04358
US

IV. Provider business mailing address

421 NECK RD 421 NECK ROAD
SOUTH CHINA ME
04358
US

V. Phone/Fax

Practice location:
  • Phone: 207-877-4931
  • Fax:
Mailing address:
  • Phone: 207-877-4931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. DIANA J BOWEN
Title or Position: OWNER
Credential:
Phone: 207-877-4931