Provider Demographics
NPI:1427194901
Name:BENNETT, BONNIE IONE (LPC, LICDC)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:IONE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 LOGAN WAY
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-3311
Mailing Address - Country:US
Mailing Address - Phone:330-259-3664
Mailing Address - Fax:330-259-3665
Practice Address - Street 1:4505 LOGAN WAY
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-3311
Practice Address - Country:US
Practice Address - Phone:330-259-3664
Practice Address - Fax:330-259-3665
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0002308101Y00000X, 101YM0800X
OH872310101YA0400X
OHAACC101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH872310OtherLICDC
OHC0002308OtherLPC