Healthcare Provider Details

I. General information

NPI: 1497600969
Provider Name (Legal Business Name): KIMBERLY BONIN CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 S HAWTHORNE RD
WINSTON SALEM NC
27103-4127
US

IV. Provider business mailing address

1617 S HAWTHORNE RD
WINSTON SALEM NC
27103-4127
US

V. Phone/Fax

Practice location:
  • Phone: 336-842-6980
  • Fax: 336-842-6984
Mailing address:
  • Phone: 336-842-6980
  • Fax: 336-842-6984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCADC-25190
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: