Doctor Name: | CARLISSA MAY BOWEN |
NPI Number: | 1730356312 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | P0806047 |
Business Practice Address: | 1425 W Main St Walnut Ridge, AR - 724761431 |
Business Phone Number: | 8708865303 |
Business Fax Number: | 8708867002 |
Mailing Address: | 1815 Pleasant Grove Rd, JONESBORO |
State: | AR |
Postal Code: | 724017870 |
Phone Number: | 8709336886 |
Fax Number: | 8709339395 |
NPI Enumeration Date: | 05/13/2008 |
NPI Last Update Date: | 02/16/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | P0806047 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |