Provider Demographics
NPI:1568050201
Name:BOWIE RUSS, DASHAMELLE JAHONA (ACSW, LMSW)
Entity Type:Individual
Prefix:
First Name:DASHAMELLE
Middle Name:JAHONA
Last Name:BOWIE RUSS
Suffix:
Gender:F
Credentials:ACSW, LMSW
Other - Prefix:
Other - First Name:DASHAMELLE
Other - Middle Name:JAHONA
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1361 S FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-2907
Mailing Address - Country:US
Mailing Address - Phone:646-309-1605
Mailing Address - Fax:
Practice Address - Street 1:5150 CANDLEWOOD ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1925
Practice Address - Country:US
Practice Address - Phone:323-334-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107077-01104100000X
CA982511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker