Provider Demographics
NPI:1588097695
Name:BONNY, NICOLE COOPER (LPC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:COOPER
Last Name:BONNY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 FLINTLOCK DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-1638
Mailing Address - Country:US
Mailing Address - Phone:610-368-8091
Mailing Address - Fax:
Practice Address - Street 1:22 FLINTLOCK DR
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-1638
Practice Address - Country:US
Practice Address - Phone:610-368-8091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00424300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional