Provider Demographics
NPI:1851785430
Name:BONYATA, VIKKI (MA/MED/CADC/LPCC)
Entity Type:Individual
Prefix:MS
First Name:VIKKI
Middle Name:
Last Name:BONYATA
Suffix:
Gender:F
Credentials:MA/MED/CADC/LPCC
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 343
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0343
Mailing Address - Country:US
Mailing Address - Phone:606-226-2531
Mailing Address - Fax:606-657-0354
Practice Address - Street 1:4963 US HWY 23 N
Practice Address - Street 2:SUITE 121
Practice Address - City:IVEL
Practice Address - State:KY
Practice Address - Zip Code:41642
Practice Address - Country:US
Practice Address - Phone:606-653-1505
Practice Address - Fax:606-657-0354
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1301101YM0800X, 101YP2500X
KY0200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)