Provider Demographics
NPI:1013080092
Name:BOWMAN, DENINE RACHELLE (PHD)
Entity Type:Individual
Prefix:
First Name:DENINE
Middle Name:RACHELLE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1534
Mailing Address - Country:US
Mailing Address - Phone:301-949-2788
Mailing Address - Fax:
Practice Address - Street 1:20 COURTHOUSE SQ
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2336
Practice Address - Country:US
Practice Address - Phone:301-424-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1153101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional