Healthcare Provider Details

I. General information

NPI: 1407587843
Provider Name (Legal Business Name): MIKAYLA RAY BOWDEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 CHERRY RD STE 201
ROCK HILL SC
29732-3118
US

IV. Provider business mailing address

455 LAKESHORE PKWY
ROCK HILL SC
29730-4205
US

V. Phone/Fax

Practice location:
  • Phone: 843-501-1099
  • Fax: 843-405-2040
Mailing address:
  • Phone: 803-909-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11448
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11448
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: