Provider Demographics
NPI:1588856397
Name:BRENNAN, BONITA J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BONITA
Middle Name:J
Last Name:BRENNAN
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 1:12016 EASTFIELD RD.
Mailing Address - Street 2:STE 327
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6637
Mailing Address - Country:US
Mailing Address - Phone:704-502-7114
Mailing Address - Fax:
Practice Address - Street 1:11800 EASTFIELD RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078
Practice Address - Country:US
Practice Address - Phone:704-502-7114
Practice Address - Fax:704-782-3005
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0054421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical