Healthcare Provider Details

I. General information

NPI: 1316088131
Provider Name (Legal Business Name): BONNIE MARIE MARROW LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 THOMPSON ST
ASHLAND VA
23005-1128
US

IV. Provider business mailing address

10299 WOODMAN RD
GLEN ALLEN VA
23060-4419
US

V. Phone/Fax

Practice location:
  • Phone: 727-205-2077
  • Fax:
Mailing address:
  • Phone: 804-727-8500
  • Fax: 804-727-8580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004011
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: