Healthcare Provider Details

I. General information

NPI: 1083101828
Provider Name (Legal Business Name): MS. BONNIE KUO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8389 REAGAN DR
KING GEORGE VA
22485-7149
US

IV. Provider business mailing address

13175 MARINA WAY APT 604
WOODBRIDGE VA
22191-1285
US

V. Phone/Fax

Practice location:
  • Phone: 804-432-8727
  • Fax:
Mailing address:
  • Phone: 714-244-8796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPRC15021
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRC15021
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC15021
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701008970
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: