Provider Demographics
NPI:1851071633
Name:BOWEN, DAMON WILLIAM (COUNSELOR)
Entity Type:Individual
Prefix:MR
First Name:DAMON
Middle Name:WILLIAM
Last Name:BOWEN
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:MR
Other - First Name:DAMON
Other - Middle Name:WILLIAM
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCA3255
Mailing Address - Street 1:3600 SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-3041
Mailing Address - Country:US
Mailing Address - Phone:443-463-3047
Mailing Address - Fax:
Practice Address - Street 1:3600 SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-3041
Practice Address - Country:US
Practice Address - Phone:410-788-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC1318101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)