Healthcare Provider Details

I. General information

NPI: 1851785430
Provider Name (Legal Business Name): VIKKI BONYATA MA/M.ED/CADC/LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4963 US HWY 23 N SUITE 121
IVEL KY
41642
US

IV. Provider business mailing address

PO BOX 343
PRESTONSBURG KY
41653-0343
US

V. Phone/Fax

Practice location:
  • Phone: 606-653-1505
  • Fax: 606-657-0354
Mailing address:
  • Phone: 606-226-2531
  • Fax: 606-657-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1301
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0200
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1301
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: