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General NPI Number Information
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NPI Number | 1811064090
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Entity Type | Individual
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Provider Name | BRENT L BOWEN MBA, MS, CFE, LMFT
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Gender | Male
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10605 JUDICIAL DR BUILDING A-4
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City | FAIRFAX
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State | VA
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Zip | 22030-5167
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Country | US
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Telephone | 703-273-6065
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Fax | 703-273-8046
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Provider Business Mailing Address
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Address Line | 10605 JUDICIAL DR BUILDING A-4
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City | FAIRFAX
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State | VA
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Zip | 22030-5167
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Country | US
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Telephone | 703-273-6065
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Fax | 703-273-8046
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717001094
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License Number State | VA
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