Provider Demographics
NPI:1558893446
Name:BOWEN, MISTY MARIE (LICSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:MISTY
Middle Name:MARIE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LICSW, PHD
Other - Prefix:DR
Other - First Name:MISTY
Other - Middle Name:MARIE
Other - Last Name:SAMYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW, PHD
Mailing Address - Street 1:5750A SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-3316
Mailing Address - Country:US
Mailing Address - Phone:251-662-7303
Mailing Address - Fax:
Practice Address - Street 1:4211 GOVERNMENT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-4813
Practice Address - Country:US
Practice Address - Phone:251-662-7317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3955C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical