Provider Demographics
NPI:1992832547
Name:BOWLES, ZETTA K (PSY D)
Entity Type:Individual
Prefix:DR
First Name:ZETTA
Middle Name:K
Last Name:BOWLES
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:DR
Other - First Name:ZETTA
Other - Middle Name:K
Other - Last Name:NICELY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:LAUREL FORK
Mailing Address - State:VA
Mailing Address - Zip Code:24352-0009
Mailing Address - Country:US
Mailing Address - Phone:276-398-1200
Mailing Address - Fax:276-398-3331
Practice Address - Street 1:14558 DANVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LAUREL FORK
Practice Address - State:VA
Practice Address - Zip Code:24352-3982
Practice Address - Country:US
Practice Address - Phone:276-398-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004791103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist