Provider Demographics
NPI:1497392633
Name:ULRICH, BONNIE LYNNE (LCSW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:LYNNE
Last Name:ULRICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 LANDRAMS RETREAT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4669
Mailing Address - Country:US
Mailing Address - Phone:540-809-2909
Mailing Address - Fax:
Practice Address - Street 1:400 LORRAINE AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1929
Practice Address - Country:US
Practice Address - Phone:540-898-1514
Practice Address - Fax:540-898-8571
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040043471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical