Provider Demographics
NPI:1083745814
Name:BOWLES, SHIRLEY ANNE (EDD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:ANNE
Last Name:BOWLES
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3542
Mailing Address - Country:US
Mailing Address - Phone:704-754-6383
Mailing Address - Fax:
Practice Address - Street 1:130 N TRADD ST
Practice Address - Street 2:SUITE D
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5240
Practice Address - Country:US
Practice Address - Phone:704-881-0129
Practice Address - Fax:704-838-1140
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3054103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000920Medicaid