Provider Demographics
NPI:1053994939
Name:BOWERS, DANDRE LATIEF
Entity type:Individual
Prefix:MR
First Name:DANDRE
Middle Name:LATIEF
Last Name:BOWERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 CENTRAL PARKWAY AVE SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4458
Mailing Address - Country:US
Mailing Address - Phone:330-406-9690
Mailing Address - Fax:
Practice Address - Street 1:1515 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6641
Practice Address - Country:US
Practice Address - Phone:330-271-8486
Practice Address - Fax:330-662-6601
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric