Provider Demographics
NPI:1598805814
Name:BOWMAN, DEMETRA I (LPCC)
Entity Type:Individual
Prefix:
First Name:DEMETRA
Middle Name:I
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:DEMETRA
Other - Middle Name:I
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:2000 EOFF ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3823
Mailing Address - Country:US
Mailing Address - Phone:304-234-8663
Mailing Address - Fax:304-234-1877
Practice Address - Street 1:2101 JACOB ST
Practice Address - Street 2:SUITE 501
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3800
Practice Address - Country:US
Practice Address - Phone:304-234-8663
Practice Address - Fax:304-234-1877
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE4346101YP2500X
WV2106101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000389894OtherANTHEM BCBS
WV001764190OtherMOUNTAIN STATE BCBS
OH801582000OtherMAGELLAN BEHAVIORAL HEALT