Provider Demographics
NPI:1144599010
Name:LUNGREN, BONNIE L (LCSW, CADC, CCDP)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:L
Last Name:LUNGREN
Suffix:
Gender:F
Credentials:LCSW, CADC, CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 WINDING RIVER LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-3568
Mailing Address - Country:US
Mailing Address - Phone:434-962-8447
Mailing Address - Fax:434-961-2556
Practice Address - Street 1:315 WINDING RIVER LN
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3568
Practice Address - Country:US
Practice Address - Phone:434-962-8447
Practice Address - Fax:434-961-2556
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040078091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical