Healthcare Provider Details

I. General information

NPI: 1164947388
Provider Name (Legal Business Name): DR. MARTHA HALEY-BOWLING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9249 FRANKLIN ST
FERRUM VA
24088
US

IV. Provider business mailing address

9249 FRANKLIN ST
FERRUM VA
24088
US

V. Phone/Fax

Practice location:
  • Phone: 540-420-1524
  • Fax:
Mailing address:
  • Phone: 540-420-1524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004380
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: