Provider Demographics
NPI:1598227043
Name:THOMPSON BOWLING, LAVINA MIRANDA (LCPC)
Entity type:Individual
Prefix:
First Name:LAVINA
Middle Name:MIRANDA
Last Name:THOMPSON BOWLING
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 GLENN DALE RD
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9207
Mailing Address - Country:US
Mailing Address - Phone:732-801-9006
Mailing Address - Fax:
Practice Address - Street 1:1300 MERCANTILE LN STE 198
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5339
Practice Address - Country:US
Practice Address - Phone:301-386-2991
Practice Address - Fax:301-386-1944
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7467101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional