Provider Demographics
NPI:1295032324
Name:BOWMAN, JANINE LYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANINE
Middle Name:LYNNE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8980
Mailing Address - Country:US
Mailing Address - Phone:704-876-1951
Mailing Address - Fax:704-876-1951
Practice Address - Street 1:105 COUNTRY DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-8980
Practice Address - Country:US
Practice Address - Phone:704-876-1951
Practice Address - Fax:704-876-1951
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2450103TS0200X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2450OtherNC LICENSED PSYCHOLOGIST - HEALTH SERVICE PROVIDER (HSP)