Provider Demographics
NPI:1770601775
Name:BOWLING, DORENE KRISTINE
Entity type:Individual
Prefix:MRS
First Name:DORENE
Middle Name:KRISTINE
Last Name:BOWLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19531 MCLANE STREET SUITE B
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262
Mailing Address - Country:US
Mailing Address - Phone:760-288-4579
Mailing Address - Fax:
Practice Address - Street 1:82632 US HIGHWAY 111
Practice Address - Street 2:SUITE A-3
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5619
Practice Address - Country:US
Practice Address - Phone:760-396-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI38830623101YA0400X
1041C0700X, 171M00000X, 390200000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program