Provider Demographics
NPI:1457194391
Name:ANDERSON, BONNIE (MSW, LCSWA, CPSS)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSW, LCSWA, CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28098-2200
Mailing Address - Country:US
Mailing Address - Phone:704-200-1021
Mailing Address - Fax:
Practice Address - Street 1:707 OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:NC
Practice Address - Zip Code:28098-2200
Practice Address - Country:US
Practice Address - Phone:704-200-1021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0208041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical