Provider Demographics
NPI:1548734023
Name:BOWEN, LORNA BEVERLY (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:LORNA
Middle Name:BEVERLY
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6194 WATERTON WAY
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3520
Mailing Address - Country:US
Mailing Address - Phone:404-547-1960
Mailing Address - Fax:770-680-5715
Practice Address - Street 1:2140 MCGEE RD STE C700
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7018
Practice Address - Country:US
Practice Address - Phone:404-547-1960
Practice Address - Fax:770-680-5715
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008065101YP2500X
GAMFT001342106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional