Individual
DR. BONITA MARIE JACKSON-VERGARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICENSED COUNSELOR
Contact information
Practice address
1545 CROSSWAYS BLVD STE 250, CHESAPEAKE, VA 23320-0218
(704) 804-9614
Mailing address
800 FOX RIDGE TRL, CHESAPEAKE, VA 23322-6506
(704) 804-9614
(757) 312-9580
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0718000386
VA
101YP2500X
Professional Counselor
0701005902
VA
101YP2500X
Professional Counselor
Primary
4804
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6103317
—
NC
Enumeration date
07/20/2006
Last updated
10/13/2021
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