Provider Demographics
NPI:1013673300
Name:BOWENS, VANESSA L (ADT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:L
Last Name:BOWENS
Suffix:
Gender:F
Credentials:ADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 GLOBE ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-6562
Mailing Address - Country:US
Mailing Address - Phone:681-242-2482
Mailing Address - Fax:
Practice Address - Street 1:201 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6695
Practice Address - Country:US
Practice Address - Phone:240-801-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)