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Individual

NICOLE BONIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSW, LCSW

Contact information

Practice address
816 WASHINGTON ST, MANITOWOC, WI 54220-4537
(920) 645-3743
Mailing address
4555 HARVEST CIR, MANITOWOC, WI 54220-9352
(920) 615-5555

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16606
WI
101YM0800X
Mental Health Counselor
1041C0700X
Clinical Social Worker
Primary
11127
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11127
LICENSED CLINICAL SOCIAL WORKER
WI
01
16606
SUBSTANCE ABUSE COUNSELOR
WI
Enumeration date
08/21/2023
Last updated
07/08/2024
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