Provider Demographics
NPI:1770842585
Name:BOWMER, SAM (MSW , LCSW)
Entity Type:Individual
Prefix:MR
First Name:SAM
Middle Name:
Last Name:BOWMER
Suffix:
Gender:M
Credentials:MSW , LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 DOMINION DR
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1532
Mailing Address - Country:US
Mailing Address - Phone:202-591-6325
Mailing Address - Fax:
Practice Address - Street 1:13649 OFFICE PL STE 102
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4215
Practice Address - Country:US
Practice Address - Phone:703-670-5738
Practice Address - Fax:703-670-8213
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040071611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical