Provider Demographics
NPI:1689423832
Name:BOWERS, HOLLIE (LCMHCA)
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:
Last Name:BOWERS
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 ROCKY CREEK LN
Mailing Address - Street 2:
Mailing Address - City:PINNACLE
Mailing Address - State:NC
Mailing Address - Zip Code:27043-8130
Mailing Address - Country:US
Mailing Address - Phone:336-978-2074
Mailing Address - Fax:
Practice Address - Street 1:469 SHADY GROVE CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5540
Practice Address - Country:US
Practice Address - Phone:704-266-3049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCBT-2024-0341101YM0800X
NCA19998101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health