Provider Demographics
NPI:1427312164
Name:BOWIE, SHARONDA LAVON
Entity type:Individual
Prefix:
First Name:SHARONDA
Middle Name:LAVON
Last Name:BOWIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N MERIDIAN AVE
Mailing Address - Street 2:SUITE 408
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-5700
Mailing Address - Country:US
Mailing Address - Phone:405-601-1716
Mailing Address - Fax:405-601-1730
Practice Address - Street 1:1328 NE 53RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111
Practice Address - Country:US
Practice Address - Phone:405-532-2597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health