Provider Demographics
NPI:1659080182
Name:BOWERS, CARLY ANNE
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:ANNE
Last Name:BOWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S MENDENHALL ST APT A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1841
Mailing Address - Country:US
Mailing Address - Phone:336-944-8490
Mailing Address - Fax:
Practice Address - Street 1:117 S MENDENHALL ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1884
Practice Address - Country:US
Practice Address - Phone:336-944-8490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician