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General NPI Number Information
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NPI Number | 1154728194
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Entity Type | Individual
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Provider Name | AMANDA RUDD BONNELL
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Gender | Female
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 823 DUNLAWTON AVE STE A
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City | PORT ORANGE
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State | FL
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Zip | 32127-4221
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Country | US
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Telephone | 877-823-4283
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Fax |
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Provider Business Mailing Address
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Address Line | 1308 PEACHTREE RD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-5956
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-16-24732
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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