Individual
CARLY ALISSA BONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.W.
Contact information
Practice address
9500 GILMAN DR DEPT 680, LA JOLLA, CA 92093-0680
(858) 534-2812
Mailing address
9500 GILMAN DR DEPT 680, LA JOLLA, CA 92093-0680
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
ASW61140
CA
101YP2500X
Professional Counselor
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/08/2011
Last updated
03/07/2017
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