Individual
BRIAN ADAM BONILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC, LPC
Contact information
Practice address
1 LONG WHARF DR STE 321, NEW HAVEN, CT 06511-5946
(203) 781-4600
(203) 781-4624
Mailing address
1 LONG WHARF DR STE 321, NEW HAVEN, CT 06511-5946
(203) 781-4600
(203) 781-4624
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1359
CT
101YP2500X
Professional Counselor
Primary
5365
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004041000
—
CT
05
—
008003745
—
CT
05
—
008092656
—
CT
Enumeration date
12/26/2019
Last updated
03/16/2023
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