Provider Demographics
NPI:1235705450
Name:HUSBAND, BONITA (CRC)
Entity Type:Individual
Prefix:DR
First Name:BONITA
Middle Name:
Last Name:HUSBAND
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 E CARRIAGEWAY DR # 503
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2032
Mailing Address - Country:US
Mailing Address - Phone:773-383-7907
Mailing Address - Fax:
Practice Address - Street 1:7 E CARRIAGEWAY DR # 503
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2032
Practice Address - Country:US
Practice Address - Phone:773-383-7907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor