Provider Demographics
NPI:1588952436
Name:BOWMAN BLEVINS, MARSHA REGINA (LCSW)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:REGINA
Last Name:BOWMAN BLEVINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:REGINA
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1350 FARRAGUT AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-3706
Mailing Address - Country:US
Mailing Address - Phone:423-571-3687
Mailing Address - Fax:
Practice Address - Street 1:809 LAMONT STREET
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040073211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical