Healthcare Provider Details

I. General information

NPI: 1598805814
Provider Name (Legal Business Name): DEMETRA I BOWMAN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEMETRA I WEAVER LPCC

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MACKEY AVE
MARTINS FERRY OH
43935-1697
US

IV. Provider business mailing address

500 MACKEY AVE
MARTINS FERRY OH
43935-1697
US

V. Phone/Fax

Practice location:
  • Phone: 740-633-4440
  • Fax: 740-633-4141
Mailing address:
  • Phone: 740-633-4440
  • Fax: 740-633-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE4346
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2106
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: