Provider Demographics
NPI:1851738546
Name:BOWEN, CHERYL A (LADC, LCMHC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LADC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:WEST CHARLESTON
Mailing Address - State:VT
Mailing Address - Zip Code:05872-0058
Mailing Address - Country:US
Mailing Address - Phone:802-723-5888
Mailing Address - Fax:
Practice Address - Street 1:3212 US ROUTE 5
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:VT
Practice Address - Zip Code:05829-9677
Practice Address - Country:US
Practice Address - Phone:802-723-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000023101YA0400X
VT068.0057723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)