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General NPI Number Information
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NPI Number | 1811122583
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Entity Type | Individual
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Provider Name | BONNIE STEPHENSON LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/23/2009
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Last Update Date | 05/23/2009
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Provider Practice Location Address
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Address Line | 209 DUNLAWTON AVE 16
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City | PORT ORANGE
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State | FL
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Zip | 32127-4472
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Country | US
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Telephone | 386-689-2283
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 N PENINSULA AVE APT 221
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-2091
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Country | US
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Telephone | 386-689-2283
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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 | MH2984
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License Number State | FL
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