Individual
RANDALL BONNOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
420 21ST AVE #113, LONGMONT, CO 80501
(303) 834-9369
Mailing address
420 21ST AVE #113, LONGMONT, CO 80501
(303) 834-9369
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACB.0008050
CO
Other
Enumeration date
08/28/2016
Last updated
08/28/2016
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