Healthcare Provider Details

I. General information

NPI: 1881519916
Provider Name (Legal Business Name): STEPHANIE DAVIS BONNAFOUX M.A.COUNSELING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 VIOLET ST
LA MESA CA
91941-7542
US

IV. Provider business mailing address

4825 BRAM AVE
BONITA CA
91902-1714
US

V. Phone/Fax

Practice location:
  • Phone: 619-825-5645
  • Fax:
Mailing address:
  • Phone: 619-971-9515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: