Provider Demographics
NPI:1083800262
Name:BOWENS, NYLA P (LPC)
Entity Type:Individual
Prefix:MRS
First Name:NYLA
Middle Name:P
Last Name:BOWENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8712 TARA BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-4905
Mailing Address - Country:US
Mailing Address - Phone:770-478-3417
Mailing Address - Fax:770-478-3419
Practice Address - Street 1:8712 TARA BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-4905
Practice Address - Country:US
Practice Address - Phone:770-478-3417
Practice Address - Fax:770-478-3419
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC000247101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional