Provider Demographics
NPI:1780148882
Name:GRANQUIST-BOWMAN, ANGELA DAWN (LPCMH)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:GRANQUIST-BOWMAN
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DAWN
Other - Last Name:GRANQUIST-BOWMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCMH
Mailing Address - Street 1:4001 KENNETT PIKE STE 244
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2029
Mailing Address - Country:US
Mailing Address - Phone:302-995-9600
Mailing Address - Fax:302-238-1506
Practice Address - Street 1:4001 KENNETT PIKE STE 244
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807-2029
Practice Address - Country:US
Practice Address - Phone:302-995-9600
Practice Address - Fax:302-238-1506
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000912101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health