Provider Demographics
NPI:1568160760
Name:SWINEA, BONITA KIMBERLY
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:KIMBERLY
Last Name:SWINEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 CRESCENT DR SW
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-3826
Mailing Address - Country:US
Mailing Address - Phone:256-308-6443
Mailing Address - Fax:
Practice Address - Street 1:1690 BELTLINE RD SW STE B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5505
Practice Address - Country:US
Practice Address - Phone:256-686-3169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BACB903378106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician