Individual
AMANDA RUDD BONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
823 DUNLAWTON AVE STE A, PORT ORANGE, FL 32127-4221
(877) 823-4283
Mailing address
1308 PEACHTREE RD, DAYTONA BEACH, FL 32114-5956
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
1-16-24732
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/19/2014
Last updated
08/09/2022
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