Provider Demographics
NPI:1558166223
Name:BONSALL, HEIDI JEAN (BT)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:JEAN
Last Name:BONSALL
Suffix:
Gender:
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 7 LKS N
Mailing Address - Street 2:
Mailing Address - City:SEVEN LAKES
Mailing Address - State:NC
Mailing Address - Zip Code:27376-9759
Mailing Address - Country:US
Mailing Address - Phone:910-603-6085
Mailing Address - Fax:
Practice Address - Street 1:1230 7 LKS N
Practice Address - Street 2:
Practice Address - City:SEVEN LAKES
Practice Address - State:NC
Practice Address - Zip Code:27376-9759
Practice Address - Country:US
Practice Address - Phone:910-603-6085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician