Provider Demographics
NPI:1366488181
Name:BRIGMAN, BONITA G (PHD)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:G
Last Name:BRIGMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PROFESSIONAL PARK DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060
Mailing Address - Country:US
Mailing Address - Phone:540-951-4800
Mailing Address - Fax:540-951-3081
Practice Address - Street 1:200 PROFESSIONAL PARK DR SE
Practice Address - Street 2:SUITE 4
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6679
Practice Address - Country:US
Practice Address - Phone:540-951-4800
Practice Address - Fax:540-951-3081
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001171101Y00000X
VA0717000664106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist