Individual
FABIENNE BONAVENTURE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
13014 5TH ST, BOWIE, MD 20720
(301) 543-0960
Mailing address
13014 5TH ST, BOWIE, MD 20720-3661
(301) 543-0960
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
OTA100000305
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTA100000305
N/A
—
Enumeration date
06/07/2018
Last updated
06/07/2018
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