Provider Demographics
NPI:1922384999
Name:BONILLA, XAVIER ANTONIO (LCPC)
Entity Type:Individual
Prefix:MR
First Name:XAVIER
Middle Name:ANTONIO
Last Name:BONILLA
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6218 MONTROSE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4119
Mailing Address - Country:US
Mailing Address - Phone:703-841-1290
Mailing Address - Fax:301-255-0110
Practice Address - Street 1:201 E ARGYLE ST
Practice Address - Street 2:APT 4
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2606
Practice Address - Country:US
Practice Address - Phone:240-216-0406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-22
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4176101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health