Healthcare Provider Details

I. General information

NPI: 1235432816
Provider Name (Legal Business Name): BONITA SALTER PERRY EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N WATER ST FL 10
MOBILE AL
36602-5010
US

IV. Provider business mailing address

64 S GEORGIA AVE
MOBILE AL
36604-2537
US

V. Phone/Fax

Practice location:
  • Phone: 251-332-1204
  • Fax:
Mailing address:
  • Phone: 251-332-1204
  • Fax: 251-434-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC06147
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: