Provider Demographics
NPI:1194359570
Name:BOWMAN, MARY E (LMFT, APC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:LMFT, APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 OLD FLOWERY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-2545
Mailing Address - Country:US
Mailing Address - Phone:770-654-4332
Mailing Address - Fax:
Practice Address - Street 1:3939 OLD FLOWERY BRANCH RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2545
Practice Address - Country:US
Practice Address - Phone:770-654-4332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001739106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA84-4861287OtherIRS