Healthcare Provider Details

I. General information

NPI: 1104776491
Provider Name (Legal Business Name): BONNIE MAE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BONNIE MAE ANDERSON-MCCLANAHAN

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 S STATE ST
DOVER DE
19901-7312
US

IV. Provider business mailing address

54 S STATE ST
DOVER DE
19901-7312
US

V. Phone/Fax

Practice location:
  • Phone: 302-257-2385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-0012010
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: