Provider Demographics
NPI:1801977137
Name:VICENTE, BARBARA BOWERS (LPA)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:BOWERS
Last Name:VICENTE
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6394 SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-9603
Mailing Address - Country:US
Mailing Address - Phone:336-287-3817
Mailing Address - Fax:336-946-2224
Practice Address - Street 1:6394 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-9603
Practice Address - Country:US
Practice Address - Phone:336-287-3817
Practice Address - Fax:336-946-2224
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2449103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107126Medicaid
NCNCMC034609OtherVALUE OPTIONS PROVIDER #