Provider Demographics
NPI:1013582337
Name:BONNER, DENSUA YALANTYS
Entity Type:Individual
Prefix:
First Name:DENSUA
Middle Name:YALANTYS
Last Name:BONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 DODSON DR CONNECTOR APT 7
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5340
Mailing Address - Country:US
Mailing Address - Phone:478-390-5179
Mailing Address - Fax:
Practice Address - Street 1:3035 STONE MOUNTAIN ST UNIT 520
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-1105
Practice Address - Country:US
Practice Address - Phone:470-344-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YS0200X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool