Provider Demographics
NPI:1447574264
Name:COLE, BONNIE K (LMFT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:K
Last Name:COLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:K
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3780 EISENHOWER PKWY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-0800
Mailing Address - Country:US
Mailing Address - Phone:478-633-5500
Mailing Address - Fax:
Practice Address - Street 1:3780 EISENHOWER PKWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-0800
Practice Address - Country:US
Practice Address - Phone:478-633-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001059106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist