Individual
BOWEN LADER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCMHCA
Contact information
Practice address
942 W 4TH ST, WINSTON SALEM, NC 27101-2582
(336) 939-5553
(336) 546-7630
Mailing address
942 W 4TH ST, WINSTON SALEM, NC 27101-2582
(336) 939-5553
(336) 546-7630
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A19135
NC
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
12/08/2021
Last updated
06/24/2024
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