Healthcare Provider Details

I. General information

NPI: 1013582337
Provider Name (Legal Business Name): DENSUA YALANTYS BONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 04/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 STONE MOUNTAIN ST UNIT 520
LITHONIA GA
30058-1105
US

IV. Provider business mailing address

3260 DODSON DR CONNECTOR APT 7
EAST POINT GA
30344-5340
US

V. Phone/Fax

Practice location:
  • Phone: 470-344-9289
  • Fax:
Mailing address:
  • Phone: 478-390-5179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: