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General NPI Number Information
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NPI Number | 1609383017
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Entity Type | Individual
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Provider Name | CHRISTY BONNER DMIN, MDIV, LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 3097 BROAD ST
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City | CHATTANOOGA
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State | TN
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Zip | 37408-3093
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Country | US
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Telephone | 423-305-2369
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Fax |
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Provider Business Mailing Address
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Address Line | 101 N BRAGG AVE
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City | LOOKOUT MOUNTAIN
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State | TN
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Zip | 37350-1261
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMT0000001263
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License Number State | TN
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