Provider Demographics
NPI:1417921164
Name:BOWDITCH, MARY W (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:W
Last Name:BOWDITCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:W
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3112 HEMLOCK HILLS LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-5730
Mailing Address - Country:US
Mailing Address - Phone:919-614-1664
Mailing Address - Fax:
Practice Address - Street 1:315 N ACADEMY ST
Practice Address - Street 2:SUITE 220
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-4540
Practice Address - Country:US
Practice Address - Phone:919-614-1664
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0040781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical