Provider Demographics
NPI:1447778592
Name:BONSALL, ALEXIS VICTORIA (LPCA, NCC)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:VICTORIA
Last Name:BONSALL
Suffix:
Gender:F
Credentials:LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1858 YELLOW DAISY DR
Mailing Address - Street 2:
Mailing Address - City:STALLINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-4149
Mailing Address - Country:US
Mailing Address - Phone:704-780-0919
Mailing Address - Fax:
Practice Address - Street 1:304 E PHIFER ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-3039
Practice Address - Country:US
Practice Address - Phone:980-224-4685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12799101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional