Provider Demographics
NPI:1205186889
Name:BOWMAN, ROLANDA C
Entity Type:Individual
Prefix:
First Name:ROLANDA
Middle Name:C
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:802 W CENTER ST
Mailing Address - Street 2:STE. D
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-9348
Mailing Address - Country:US
Mailing Address - Phone:512-202-0102
Mailing Address - Fax:
Practice Address - Street 1:802 W CENTER ST
Practice Address - Street 2:STE. D
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-9348
Practice Address - Country:US
Practice Address - Phone:512-202-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11819101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)