Provider Demographics
NPI:1578106811
Name:BOWLING-NGUYEN, LAURA (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:BOWLING-NGUYEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26072 JAWAHER PL
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-6205
Mailing Address - Country:US
Mailing Address - Phone:703-608-4286
Mailing Address - Fax:
Practice Address - Street 1:19415 DEERFIELD AVE STE 316
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8472
Practice Address - Country:US
Practice Address - Phone:571-831-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040130921041C0700X
VAPPS-06070041041S0200X
VAPROV-06495841041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904013092OtherCLINICAL LICENSE