MEDICARE: HOLLIE BOWERS 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	CBT-2024-0341	NM
2	101YM0800X	Mental Health Counselor	A19998	NC

General Provider Information

NPI Number	:	1689423832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLIE BOWERS LCMHCA

Provider Business Mailing Address
First Line	:	1050 ROCKY CREEK LN
Second Line	:
City	:	PINNACLE
State	:	NC
Zip	:	27043-8130
Country	:	US
Telephone Number	:	336-978-2074
Fax Number	:

Provider Business Practice Location Address
First Line	:	469 SHADY GROVE CT
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5540
Country	:	US
Telephone Number	:	704-266-3049
Fax Number	:

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

Provider Enumeration Date	:	05/17/2024
Last Update Date	:	05/17/2024

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Directions to “ HOLLIE BOWERS LCMHCA” Practice Location

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