Provider Demographics
NPI:1073871331
Name:BONDS, ALVIN G II (LPC/MHSP)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:G
Last Name:BONDS
Suffix:II
Gender:M
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 934
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-0934
Mailing Address - Country:US
Mailing Address - Phone:731-868-7297
Mailing Address - Fax:877-273-4824
Practice Address - Street 1:384 CARRIAGE HOUSE DR STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2268
Practice Address - Country:US
Practice Address - Phone:731-487-3595
Practice Address - Fax:877-273-4824
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2865101YP2500X, 101YM0800X
TN990106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ006528Medicaid