Provider Demographics
NPI:1417241977
Name:BOWERS, MOLLIE (LGSW)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:BOWERS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 W CLAIBORNE ST
Mailing Address - Street 2:PO BOX 964
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36460-1738
Mailing Address - Country:US
Mailing Address - Phone:251-575-4203
Mailing Address - Fax:251-575-9409
Practice Address - Street 1:1321 MCMILLAN AVE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1324
Practice Address - Country:US
Practice Address - Phone:251-867-3242
Practice Address - Fax:251-867-7151
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2872G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker