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Individual
BONITA HAGBOM
Active
Individual
BONITA HAGBOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACLC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
BBH-ACLC-LIC-71887
MT
101YA0400X
Addiction (Substance Use Disorder) Counselor
CO61295697
WA
Other
Enumeration date
04/18/2022
Last updated
10/01/2024
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