Provider Demographics
NPI:1295900579
Name:BOWDEN, ROBERT BLYTHE (L C P C)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BLYTHE
Last Name:BOWDEN
Suffix:
Gender:M
Credentials:L C P C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5622 CRESCENT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1149
Mailing Address - Country:US
Mailing Address - Phone:410-830-9268
Mailing Address - Fax:410-734-6123
Practice Address - Street 1:2909 CHURCHVILLE RD
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:MD
Practice Address - Zip Code:21028-1809
Practice Address - Country:US
Practice Address - Phone:410-734-6439
Practice Address - Fax:410-734-6123
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health