Provider Demographics
NPI:1578183026
Name:BOWERS, GINA M (MED, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:BOWERS
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1401
Mailing Address - Country:US
Mailing Address - Phone:717-884-8424
Mailing Address - Fax:
Practice Address - Street 1:3320 N 2ND ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1401
Practice Address - Country:US
Practice Address - Phone:717-884-8424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000204101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor