Provider Demographics
NPI:1285756403
Name:BONTRAGER, KAY J (LPC)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:J
Last Name:BONTRAGER
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 1:155 AUTUMN FROST AVE
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-9058
Mailing Address - Country:US
Mailing Address - Phone:704-528-1607
Mailing Address - Fax:
Practice Address - Street 1:3009 AMITY HILL RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-9710
Practice Address - Country:US
Practice Address - Phone:704-682-0989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3995101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional