Provider Demographics
NPI:1992234009
Name:BOWMAN, MADELYN WHITLEY (LISWCP)
Entity type:Individual
Prefix:MRS
First Name:MADELYN
Middle Name:WHITLEY
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:LISWCP
Other - Prefix:
Other - First Name:MADELYN
Other - Middle Name:A
Other - Last Name:WHITLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSW
Mailing Address - Street 1:4211 N OKATIE HWY
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936
Mailing Address - Country:US
Mailing Address - Phone:843-645-3838
Mailing Address - Fax:
Practice Address - Street 1:1624 WESTGATE CIR STE 100
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8091
Practice Address - Country:US
Practice Address - Phone:615-221-7075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSW15416CP1041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker