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General NPI Number Information
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NPI Number | 1780148882
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Entity Type | Individual
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Provider Name | ANGELA DAWN GRANQUIST-BOWMAN LPCMH
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Gender | Female
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 4001 KENNETT PIKE STE 244
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City | WILMINGTON
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State | DE
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Zip | 19807-2029
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Country | US
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Telephone | 302-995-9600
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Fax | 302-238-1506
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Provider Business Mailing Address
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Address Line | 4001 KENNETT PIKE STE 244
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City | WILMINGTON
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State | DE
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Zip | 19807-2029
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Country | US
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Telephone | 302-995-9600
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Fax | 302-238-1506
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PC-0000912
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License Number State | DE
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