Provider Demographics
NPI:1497470264
Name:BOWIE, BENJAMIN (CADC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:BOWIE
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 PARK ST STE 302
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7195
Mailing Address - Country:US
Mailing Address - Phone:207-333-1080
Mailing Address - Fax:207-777-4649
Practice Address - Street 1:37 PARK ST STE 302
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7195
Practice Address - Country:US
Practice Address - Phone:207-333-1080
Practice Address - Fax:207-777-4649
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC8200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)