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General NPI Number Information
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NPI Number | 1609169929
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Entity Type | Individual
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Provider Name | VERA LAVONNE BOWIE LISW
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Gender | Female
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Dates
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Enumeration Date | 05/19/2011
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Last Update Date | 05/19/2011
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Provider Practice Location Address
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Address Line | AREA A, BUILDING 830, ROOM BHH1-24
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City | WPAFB
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State | OH
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Zip | 45433
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Country | US
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Telephone | 937-257-8058
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Fax |
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Provider Business Mailing Address
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Address Line | 648 POSSUM HOLLOW TRL
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City | GERRARDSTOWN
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State | WV
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Zip | 25420-3025
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Country | US
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Telephone | 703-297-5495
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I0008070
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License Number State | OH
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