Provider Demographics
NPI:1891025300
Name:BONHAM, ERICA JEANNETTE (MASTERS CANADATE)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:JEANNETTE
Last Name:BONHAM
Suffix:
Gender:F
Credentials:MASTERS CANADATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8795 RALSTON RD STE 200A
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-2358
Mailing Address - Country:US
Mailing Address - Phone:303-880-7793
Mailing Address - Fax:303-730-3339
Practice Address - Street 1:8795 RALSTON RD STE 200A
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-2358
Practice Address - Country:US
Practice Address - Phone:303-880-7793
Practice Address - Fax:303-730-3339
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO011279101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health