MEDICARE: SAMANTHA NICOLE BOWLING LCMHCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	A20909	NC

General Provider Information

NPI Number	:	1194522862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA NICOLE BOWLING LCMHCA

Provider Business Mailing Address
First Line	:	706 WILDCAT RD
Second Line	:
City	:	DEEP GAP
State	:	NC
Zip	:	28618-9273
Country	:	US
Telephone Number	:	828-406-6075
Fax Number	:

Provider Business Practice Location Address
First Line	:	7301 CARMEL EXECUTIVE PARK DR STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4207
Country	:	US
Telephone Number	:	828-406-6075
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2025
Last Update Date	:	02/28/2025

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