Healthcare Provider Details

I. General information

NPI: 1265896401
Provider Name (Legal Business Name): CHERYL A BOWDEN LCDC II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 NORTHLAND BLVD
CINCINNATI OH
45240-3248
US

IV. Provider business mailing address

7597 BRIDGETOWN RD
CINCINNATI OH
45248-2019
US

V. Phone/Fax

Practice location:
  • Phone: 513-959-5344
  • Fax: 513-648-9859
Mailing address:
  • Phone: 513-941-4999
  • Fax: 513-648-9859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDC.111056-2
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: