Provider Demographics
NPI:1114349867
Name:BOWMAN, GLEN (CLINICAL PSYCHOLOGIS)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:CLINICAL PSYCHOLOGIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 COMMONWEALTH DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1622
Mailing Address - Country:US
Mailing Address - Phone:434-812-4009
Mailing Address - Fax:
Practice Address - Street 1:2300 COMMONWEALTH DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1622
Practice Address - Country:US
Practice Address - Phone:434-812-4009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002117103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical