Provider Demographics
NPI:1073722401
Name:BONAMY, DWAYNE ALEX (LMHC, CAP)
Entity Type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:ALEX
Last Name:BONAMY
Suffix:
Gender:M
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 NW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5912
Mailing Address - Country:US
Mailing Address - Phone:954-973-9352
Mailing Address - Fax:
Practice Address - Street 1:3275 NW 99TH WAY
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4024
Practice Address - Country:US
Practice Address - Phone:954-341-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2054101YA0400X
FLMH7779101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health