Provider Demographics
NPI:1508250150
Name:KINGSTEINKAMP, BONITA GAYE (MH, CTHA)
Entity Type:Individual
Prefix:MS
First Name:BONITA
Middle Name:GAYE
Last Name:KINGSTEINKAMP
Suffix:
Gender:F
Credentials:MH, CTHA
Other - Prefix:
Other - First Name:HYPNOSIS
Other - Middle Name:ENTERPRISES
Other - Last Name:INC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MH, CTHA
Mailing Address - Street 1:7004 OAKENSHAW DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32466-8380
Mailing Address - Country:US
Mailing Address - Phone:619-322-2595
Mailing Address - Fax:
Practice Address - Street 1:1713 BECK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2566
Practice Address - Country:US
Practice Address - Phone:850-403-8017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-21
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270697174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist