Provider Demographics
NPI:1255691143
Name:BOHART, VIRGINIA (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:BOHART
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ALONDRA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8316
Mailing Address - Country:US
Mailing Address - Phone:505-466-1197
Mailing Address - Fax:
Practice Address - Street 1:50 ALONDRA RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-8316
Practice Address - Country:US
Practice Address - Phone:505-466-1197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0070841101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health