Healthcare Provider Details

I. General information

NPI: 1992855985
Provider Name (Legal Business Name): GRACE M BOWEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 BUSH RIVER DRIVE
FARMVILLE VI
23901
US

IV. Provider business mailing address

P.O. DRAWER 248
FARMVILLE VI
23901
US

V. Phone/Fax

Practice location:
  • Phone: 434-392-3187
  • Fax: 434-392-5789
Mailing address:
  • Phone: 434-392-3187
  • Fax: 434-392-5789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006481
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: