Provider Demographics
NPI:1013385095
Name:THOMAS BOWMAN, ANNETTE
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:THOMAS BOWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:TERESA
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1131 CUNNINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3078
Mailing Address - Country:US
Mailing Address - Phone:415-492-0818
Mailing Address - Fax:415-492-0834
Practice Address - Street 1:1131 CUNNINGHAM ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3078
Practice Address - Country:US
Practice Address - Phone:415-492-0818
Practice Address - Fax:415-492-0834
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)