Provider Demographics
NPI:1295230191
Name:BOWMAN, MARVELLA ALEXANDRIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARVELLA
Middle Name:ALEXANDRIA
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 1:831 W MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1613
Mailing Address - Country:US
Mailing Address - Phone:984-255-6199
Mailing Address - Fax:
Practice Address - Street 1:831 W MORGAN ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1613
Practice Address - Country:US
Practice Address - Phone:984-255-6199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-24
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5023103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist