Provider Demographics
NPI:1871176180
Name:BOWERS, BRETT (LCMHCS, LCAS)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:BOWERS
Suffix:
Gender:M
Credentials:LCMHCS, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-4630
Mailing Address - Country:US
Mailing Address - Phone:919-801-9010
Mailing Address - Fax:
Practice Address - Street 1:2903 BUCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-4630
Practice Address - Country:US
Practice Address - Phone:919-801-9010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21607101YA0400X
NC171400000X
NCS6853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC21607OtherLICENSED CLINICAL ADDICTIONS SPECIALIST
NCS6857OtherLICENSED CLINICAL MENTAL HEALTH COUNSELOR SUPERVISOR