Provider Demographics
NPI:1811122583
Name:STEPHENSON, BONNIE (LMHC)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 N PENINSULA AVE APT 221
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-2091
Mailing Address - Country:US
Mailing Address - Phone:386-689-2283
Mailing Address - Fax:
Practice Address - Street 1:209 DUNLAWTON AVE
Practice Address - Street 2:16
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4472
Practice Address - Country:US
Practice Address - Phone:386-689-2283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-23
Last Update Date:2009-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2984101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health