Provider Demographics
NPI:1760247159
Name:BOWEN, ANTONETTE PATRICE (RBT)
Entity Type:Individual
Prefix:
First Name:ANTONETTE
Middle Name:PATRICE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 SHAKER FALLS LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7297
Mailing Address - Country:US
Mailing Address - Phone:678-478-3262
Mailing Address - Fax:
Practice Address - Street 1:1948 SHAKER FALLS LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7297
Practice Address - Country:US
Practice Address - Phone:678-478-3262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-23-282766106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician