Healthcare Provider Details

I. General information

NPI: 1073291795
Provider Name (Legal Business Name): DWELL MINISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 PINEDALE RD STE B
GREENSBORO NC
27408-2018
US

IV. Provider business mailing address

2709 PINEDALE RD STE B
GREENSBORO NC
27408-2018
US

V. Phone/Fax

Practice location:
  • Phone: 434-327-7624
  • Fax:
Mailing address:
  • Phone: 434-327-7624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LAUREN BOWMAN
Title or Position: PRESIDENT, CLINICAL THERAPIST
Credential: MA, LCMHC
Phone: 317-746-8900