Provider Demographics
NPI:1033303342
Name:BONNER, CHRISTOPHER WALLACE (MSW)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WALLACE
Last Name:BONNER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-2329
Mailing Address - Country:US
Mailing Address - Phone:615-942-8076
Mailing Address - Fax:615-366-1351
Practice Address - Street 1:1403 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-2329
Practice Address - Country:US
Practice Address - Phone:615-942-8076
Practice Address - Fax:615-366-1351
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9860871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical