Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 1089 | LA |
NPI | 1003055948 |
---|---|
Provider Name | Mr. Calvin Gene Bowlin |
First Address | New Orleans, LA 70119 |
Second Address | New Orleans, LA 70119-7462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2009 |
Last Update Date | 17/02/2009 |