Provider Demographics
NPI:1073283537
Name:BOWLES, SUSAN CAROLINE (LCSWA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CAROLINE
Last Name:BOWLES
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:BOWLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSWA
Mailing Address - Street 1:39 S SUSSEX DR
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4743
Mailing Address - Country:US
Mailing Address - Phone:919-896-0707
Mailing Address - Fax:
Practice Address - Street 1:1319 N BRIGHTLEAF BLVD STE F
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4876
Practice Address - Country:US
Practice Address - Phone:919-934-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0207341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical