Provider Demographics
NPI:1821530908
Name:BONNER, ALEXANDRA CHERE-TRINA (LCSW-A)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:CHERE-TRINA
Last Name:BONNER
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 KINGS RIDGE DR
Mailing Address - Street 2:APT 104
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-5958
Mailing Address - Country:US
Mailing Address - Phone:502-810-4476
Mailing Address - Fax:
Practice Address - Street 1:7505 KINGS RIDGE DR
Practice Address - Street 2:APT 104
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-5958
Practice Address - Country:US
Practice Address - Phone:502-810-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP-0110721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical