Individual
CANDICE ROQUEMORE BONNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD, LCP
Contact information
Practice address
1000 E BROAD ST, RICHMOND, VA 23219-1930
(804) 828-2467
(804) 828-6690
Mailing address
PO BOX 780125, PHILADELPHIA, PA 19178-0125
(804) 922-4844
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810008266
VA
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
04/03/2020
Last updated
10/18/2023
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