Basic Information
| Provider Information | |||||||||
| NPI: | 1720133390 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOWENS | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S., L.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 313 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284014067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103432901 | ||||||||
| FaxNumber: | 9103434227 | ||||||||
| Practice Location | |||||||||
| Address1: | 313 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284014067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103432901 | ||||||||
| FaxNumber: | 9103434227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4970 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 6103020 | 05 | NC | MEDICAID |