Healthcare Provider Details

I. General information

NPI: 1780464891
Provider Name (Legal Business Name): ALISHA BOWMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 PROVIDENCE RD STE 20
VIRGINIA BEACH VA
23464-4128
US

IV. Provider business mailing address

326 ELDERWOOD CT
VIRGINIA BEACH VA
23462-4355
US

V. Phone/Fax

Practice location:
  • Phone: 757-347-8840
  • Fax: 757-829-1667
Mailing address:
  • Phone: 276-806-4764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904015829
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: