Provider Demographics
NPI:1083273031
Name:VON BONSDORFF, GHITA MARIA
Entity Type:Individual
Prefix:
First Name:GHITA
Middle Name:MARIA
Last Name:VON BONSDORFF
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 1:8455 FENTON ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4995
Mailing Address - Country:US
Mailing Address - Phone:202-258-6105
Mailing Address - Fax:
Practice Address - Street 1:8455 FENTON ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4995
Practice Address - Country:US
Practice Address - Phone:202-258-6105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health