Provider Demographics
NPI:1699128421
Name:BOWSER, SAMARA (LCSWA)
Entity type:Individual
Prefix:MRS
First Name:SAMARA
Middle Name:
Last Name:BOWSER
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 HIDDEN TREASURE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-1466
Mailing Address - Country:US
Mailing Address - Phone:919-316-9234
Mailing Address - Fax:919-572-8833
Practice Address - Street 1:2216 S MIAMI BLVD STE 203
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6284
Practice Address - Country:US
Practice Address - Phone:919-316-9234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-16
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP010580101YM0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health