Provider Demographics
NPI:1720133390
Name:BOWENS, ANNA RENEE (MS, LPC)
Entity Type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:RENEE
Last Name:BOWENS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4067
Mailing Address - Country:US
Mailing Address - Phone:910-343-2901
Mailing Address - Fax:910-343-4227
Practice Address - Street 1:313 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4067
Practice Address - Country:US
Practice Address - Phone:910-343-2901
Practice Address - Fax:910-343-4227
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4970101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103020Medicaid