Provider Demographics
NPI:1811064090
Name:BOWEN, BRENT L (MBA, MS, CFE, LMFT)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:L
Last Name:BOWEN
Suffix:
Gender:M
Credentials:MBA, MS, CFE, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10605 JUDICIAL DR
Mailing Address - Street 2:BUILDING A-4
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5167
Mailing Address - Country:US
Mailing Address - Phone:703-273-6065
Mailing Address - Fax:703-273-8046
Practice Address - Street 1:10605 JUDICIAL DR
Practice Address - Street 2:BUILDING A-4
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5167
Practice Address - Country:US
Practice Address - Phone:703-273-6065
Practice Address - Fax:703-273-8046
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001094106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist