Provider Demographics
NPI:1053602904
Name:BOWES, VIRGINIA WALKER (LCPC (CC4382))
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:WALKER
Last Name:BOWES
Suffix:
Gender:F
Credentials:LCPC (CC4382)
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:PO BOX 1126
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1126
Mailing Address - Country:US
Mailing Address - Phone:207-615-9692
Mailing Address - Fax:207-255-0555
Practice Address - Street 1:110 TANDBERG TRL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5206
Practice Address - Country:US
Practice Address - Phone:207-615-9692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME101YM0800X
MECC4382101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health