Healthcare Provider Details

I. General information

NPI: 1306792759
Provider Name (Legal Business Name): CARL BONIOL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7742 OFFICE PARK BLVD STE C2
BATON ROUGE LA
70809-8636
US

IV. Provider business mailing address

7742 OFFICE PARK BLVD STE C2
BATON ROUGE LA
70809-8636
US

V. Phone/Fax

Practice location:
  • Phone: 225-448-0440
  • Fax:
Mailing address:
  • Phone: 225-448-0440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: