Provider Demographics
NPI:1437692357
Name:STEVENS, BONNIE (LPC, LAC, NCC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LPC, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 E HAWTHORN PKWY
Mailing Address - Street 2:SUITE 235
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1463
Mailing Address - Country:US
Mailing Address - Phone:847-868-3435
Mailing Address - Fax:
Practice Address - Street 1:1873 MARLTON PIKE E
Practice Address - Street 2:SUITE 2C
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2034
Practice Address - Country:US
Practice Address - Phone:732-982-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-25
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00707900101YP2500X
NJ37AC00317000101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional