Provider Demographics
NPI:1558438184
Name:MATYAS, BONNIE (LPC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:MATYAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8885
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908
Mailing Address - Country:US
Mailing Address - Phone:706-507-3574
Mailing Address - Fax:706-507-3578
Practice Address - Street 1:1443 2ND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901
Practice Address - Country:US
Practice Address - Phone:706-505-3574
Practice Address - Fax:706-507-3578
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003613101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional