Provider Demographics
NPI:1114591773
Name:BOWLIN, GINA LORI (LCSW)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:LORI
Last Name:BOWLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:LORI
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1691
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-1691
Mailing Address - Country:US
Mailing Address - Phone:606-620-3936
Mailing Address - Fax:
Practice Address - Street 1:1707 CUMBERLAND FALLS HWY STE L6
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2745
Practice Address - Country:US
Practice Address - Phone:606-620-3936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY279337101YA0400X
KY2556601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)