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General NPI Number Information
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NPI Number | 1609365097
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Entity Type | Organization
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Legal Business Name | BOWEN PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 5599 FISH HAWK CT
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City | WALDORF
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State | MD
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Zip | 20601-4543
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Country | US
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Telephone | 301-448-0818
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Fax |
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Provider Business Mailing Address
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Address Line | 150 POST OFFICE RD UNIT 827
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City | WALDORF
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State | MD
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Zip | 20604-7533
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Country | US
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Telephone | 301-448-0818
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DESNEY BOWEN
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Credential | LCPC
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Telephone | 301-448-0818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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