Provider Demographics
NPI:1063753002
Name:BONVILLAIN, ASHLEY ANN (LPC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:BONVILLAIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 EASTBROOK BND
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1565
Mailing Address - Country:US
Mailing Address - Phone:770-486-1140
Mailing Address - Fax:678-669-2693
Practice Address - Street 1:23 EASTBROOK BND
Practice Address - Street 2:SUITE 200
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1565
Practice Address - Country:US
Practice Address - Phone:770-486-1140
Practice Address - Fax:678-669-2693
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006412101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional