Provider Demographics
NPI:1588977789
Name:BONNER, TRACEY (CADC-LL)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:BONNER
Suffix:
Gender:F
Credentials:CADC-LL
Other - Prefix:MRS
Other - First Name:TRACEY
Other - Middle Name:DENISE
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC-LL
Mailing Address - Street 1:850 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5230
Mailing Address - Country:US
Mailing Address - Phone:909-421-4660
Mailing Address - Fax:909-421-9392
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-9479
Practice Address - Fax:909-421-9392
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA021970216101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)