Provider Demographics
NPI:1518936988
Name:BOWERS, RICHARD C JR (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:BOWERS
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1997
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-0997
Mailing Address - Country:US
Mailing Address - Phone:804-732-1527
Mailing Address - Fax:804-732-8210
Practice Address - Street 1:43 RIVES RD
Practice Address - Street 2:SUITE B
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9255
Practice Address - Country:US
Practice Address - Phone:804-732-1527
Practice Address - Fax:804-732-8210
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002206103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P91424Medicare UPIN
00V438C29Medicare ID - Type Unspecified