Provider Demographics
NPI:1285932889
Name:BOWDEN, VERONICA CARLOTTA
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:CARLOTTA
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VERONICA
Other - Middle Name:CARLOTTA
Other - Last Name:COBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2178 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4535
Mailing Address - Country:US
Mailing Address - Phone:805-781-4700
Mailing Address - Fax:
Practice Address - Street 1:2178 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4535
Practice Address - Country:US
Practice Address - Phone:805-903-1905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-05
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32740101YM0800X, 167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health