Healthcare Provider Details

I. General information

NPI: 1073283537
Provider Name (Legal Business Name): SUSAN CAROLINE BOWLES LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN BOWLES LCSWA

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 08/16/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 N BRIGHTLEAF BLVD STE F
SMITHFIELD NC
27577-4876
US

IV. Provider business mailing address

39 S SUSSEX DR
SMITHFIELD NC
27577-4743
US

V. Phone/Fax

Practice location:
  • Phone: 919-934-1312
  • Fax:
Mailing address:
  • Phone: 919-896-0707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP020734
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: