Provider Demographics
NPI:1528232980
Name:COX, BONITA I (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:I
Last Name:COX
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-3262
Mailing Address - Country:US
Mailing Address - Phone:765-642-3363
Mailing Address - Fax:
Practice Address - Street 1:501 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-3430
Practice Address - Country:US
Practice Address - Phone:765-643-6017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005377A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical