Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LCAS-22697 | NC |
Y | 104100000X | Social Worker | C011390 | NC |
NPI | 1003276742 |
---|---|
Provider Name | Amy Bowden |
First Address | Winston Salem, NC 27101-2701 |
Second Address | Winston Salem, NC 27101-2701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2016 |
Last Update Date | 02/01/2020 |