Individual
DANIELLE R BONICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5357 CHAPEL HILL RD, DOUGLASVILLE, GA 30135-5027
(770) 942-4742
(770) 293-0786
Mailing address
4131 HIGH COUNTRY DR, DOUGLASVILLE, GA 30135-4265
(678) 656-8249
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW004789
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2028016137
MEDICARE PTAN
GA
01
—
4829878
CIGNA
GA
01
—
81-3033255
REVIVAL COUNSELING SERVICES
GA
01
—
97924545
BLUE CROSS BLUE SHIELD
GA
Enumeration date
03/26/2013
Last updated
09/14/2016
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