Provider Demographics
NPI:1467090886
Name:BOWMAN, BLAIR MARINI (LCSW, CEDS-S)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:MARINI
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:LCSW, CEDS-S
Other - Prefix:
Other - First Name:BLAIR
Other - Middle Name:ELIZABETH
Other - Last Name:MARINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2709 GRAYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-5103
Mailing Address - Country:US
Mailing Address - Phone:704-771-4752
Mailing Address - Fax:
Practice Address - Street 1:406 W FRANKLIN ST STE 201
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4906
Practice Address - Country:US
Practice Address - Phone:804-596-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0129961041C0700X
VA09040131641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical