Provider Demographics
NPI:1760914337
Name:BOWMAN, MOLLY (PSYD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 FAIRFAX AVE
Mailing Address - Street 2:SUITE 710
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1914
Mailing Address - Country:US
Mailing Address - Phone:757-446-5918
Mailing Address - Fax:757-446-5881
Practice Address - Street 1:755 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801
Practice Address - Country:US
Practice Address - Phone:847-924-9288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-01
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006051103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical