Provider Demographics
NPI:1578006524
Name:BOWLING, DANITA (JD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DANITA
Middle Name:
Last Name:BOWLING
Suffix:
Gender:F
Credentials:JD, PHD
Other - Prefix:
Other - First Name:DANITA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5008 GLENVIEW EXT DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-2882
Mailing Address - Country:US
Mailing Address - Phone:315-225-8171
Mailing Address - Fax:
Practice Address - Street 1:114 CLINTON ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2212
Practice Address - Country:US
Practice Address - Phone:607-797-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
NC5400103TC0700X
NY022888103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical