Provider Demographics
NPI:1003097635
Name:DULANEY, BONNETT NA (LPC)
Entity Type:Individual
Prefix:
First Name:BONNETT
Middle Name:NA
Last Name:DULANEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 ASQUITH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-6001
Mailing Address - Country:US
Mailing Address - Phone:770-861-8227
Mailing Address - Fax:
Practice Address - Street 1:1330 CONCORD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4375
Practice Address - Country:US
Practice Address - Phone:770-861-8227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004123171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator