Provider Demographics
NPI:1891230421
Name:BONHOMIE, L.L.C.
Entity Type:Organization
Organization Name:BONHOMIE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CORLETHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NORMAN-BEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-402-0650
Mailing Address - Street 1:1705 HIGHWAY 138 SE UNIT 83365
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-0162
Mailing Address - Country:US
Mailing Address - Phone:404-402-0650
Mailing Address - Fax:
Practice Address - Street 1:2375 WALL ST SE STE OFFICE34
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6702
Practice Address - Country:US
Practice Address - Phone:404-402-0650
Practice Address - Fax:404-341-9834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW005255251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health