Provider Demographics
NPI:1205186095
Name:WATSON, BONNIE MARIE (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:MARIE
Last Name:WATSON
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7778 VAL DEL RD
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620-6427
Mailing Address - Country:US
Mailing Address - Phone:229-507-7156
Mailing Address - Fax:
Practice Address - Street 1:7778 VAL DEL RD
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-6427
Practice Address - Country:US
Practice Address - Phone:229-507-7156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2016-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174H00000XOther Service ProvidersHealth Educator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program