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General NPI Number Information
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NPI Number | 1962284083
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Entity Type | Individual
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Provider Name | MAURESHA MARCHELL BOWDEN LMSW
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Gender | Female
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 2774 COBB PKWY NW STE 109-140
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City | KENNESAW
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State | GA
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Zip | 30152-3469
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Country | US
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Telephone | 770-693-1086
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 871
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City | RED OAK
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State | GA
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Zip | 30272-0871
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Country | US
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Telephone | 404-621-5956
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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 | MSW009046
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License Number State | GA
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