Provider Demographics
NPI:1407424542
Name:BONNER, MADELINE PAIGE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:PAIGE
Last Name:BONNER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5561 MCNEELY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7625
Mailing Address - Country:US
Mailing Address - Phone:919-667-8789
Mailing Address - Fax:
Practice Address - Street 1:5561 MCNEELY DR STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-7625
Practice Address - Country:US
Practice Address - Phone:984-305-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0163031041C0700X
NCC0163471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical