Provider Demographics
NPI:1306984299
Name:BARKER, BONITA POLOSKY (LPC)
Entity type:Individual
Prefix:
First Name:BONITA
Middle Name:POLOSKY
Last Name:BARKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BONITA
Other - Middle Name:POLOSKY
Other - Last Name:MURDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:26 E JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-2219
Mailing Address - Country:US
Mailing Address - Phone:478-731-2229
Mailing Address - Fax:478-992-9094
Practice Address - Street 1:26 E JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-2219
Practice Address - Country:US
Practice Address - Phone:478-731-2229
Practice Address - Fax:478-992-9094
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2182101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional