Provider Demographics
NPI:1912589706
Name:BOWEN, GRACE ELIZABETH
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ELIZABETH
Last Name:BOWEN
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 1:152 FRANKS FORK RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-7952
Mailing Address - Country:US
Mailing Address - Phone:919-710-4050
Mailing Address - Fax:
Practice Address - Street 1:8562 NORTH CAROLINA 105S
Practice Address - Street 2:UNIT 102
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28604-2860
Practice Address - Country:US
Practice Address - Phone:818-333-4170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0135561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical