Provider Demographics
NPI:1376808808
Name:BOWMAN, DAVID (CEO)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 E MAIN ST
Mailing Address - Street 2:#14
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7069
Mailing Address - Country:US
Mailing Address - Phone:804-385-9679
Mailing Address - Fax:
Practice Address - Street 1:2025 EAST MAIN ST
Practice Address - Street 2:#14
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223
Practice Address - Country:US
Practice Address - Phone:804-385-9679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1517-03-001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health