Provider Demographics
NPI:1386730604
Name:BONILLA, HEATHER M (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:BONILLA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3482 PEACEFUL FARM DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-7129
Mailing Address - Country:US
Mailing Address - Phone:831-241-4326
Mailing Address - Fax:
Practice Address - Street 1:581 EXECUTIVE PL STE 500
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5794
Practice Address - Country:US
Practice Address - Phone:910-705-1797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0033481041C0700X
NCC0057981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical