Healthcare Provider Details

I. General information

NPI: 1487347647
Provider Name (Legal Business Name): ADRIANA L BOWEN L.P.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 MACIEL DR NW
ALBUQUERQUE NM
87104-1976
US

IV. Provider business mailing address

1123 MACIEL DR NW
ALBUQUERQUE NM
87104-1976
US

V. Phone/Fax

Practice location:
  • Phone: 575-956-8354
  • Fax:
Mailing address:
  • Phone: 575-956-8354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0208931
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: