Individual
CHARLENE MARIE BONNER
Active
Individual
CHARLENE MARIE BONNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
8742
—
103TC1900X
Counseling Psychologist
Primary
8742
MA
Other
Enumeration date
05/10/2018
Last updated
05/10/2018
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