Provider Demographics
NPI:1114261252
Name:WALLS, BONNIE LOUISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LOUISE
Last Name:WALLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E SILVER SPRINGS BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-6831
Mailing Address - Country:US
Mailing Address - Phone:352-547-1595
Mailing Address - Fax:352-369-9483
Practice Address - Street 1:1515 E SILVER SPRINGS BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6831
Practice Address - Country:US
Practice Address - Phone:352-547-1595
Practice Address - Fax:352-369-9483
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 75051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical