Provider Demographics
NPI:1366916561
Name:BOWLES, LADONDRA KIANTE (MS)
Entity type:Individual
Prefix:MS
First Name:LADONDRA
Middle Name:KIANTE
Last Name:BOWLES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7174 HIGHWAY 103
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70589-4420
Mailing Address - Country:US
Mailing Address - Phone:337-578-2959
Mailing Address - Fax:
Practice Address - Street 1:805 S UNION ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6029
Practice Address - Country:US
Practice Address - Phone:337-331-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health