Provider Demographics
NPI:1285876458
Name:BONNIE JESSEE INC.
Entity type:Organization
Organization Name:BONNIE JESSEE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:JESSEE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, RN
Authorized Official - Phone:276-676-2128
Mailing Address - Street 1:26054 CORNELIUS DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-6362
Mailing Address - Country:US
Mailing Address - Phone:276-676-2128
Mailing Address - Fax:276-628-9594
Practice Address - Street 1:335 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2905
Practice Address - Country:US
Practice Address - Phone:276-628-2510
Practice Address - Fax:276-628-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040067391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty