Provider Demographics
NPI:1942754593
Name:AHLQUIST, BONNIE L (LPC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:AHLQUIST
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 W STRASBURG RD
Mailing Address - Street 2:APT 4
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-1602
Mailing Address - Country:US
Mailing Address - Phone:610-420-0629
Mailing Address - Fax:
Practice Address - Street 1:744 E LINCOLN HWY
Practice Address - Street 2:SUITE 420
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-3590
Practice Address - Country:US
Practice Address - Phone:610-353-5635
Practice Address - Fax:484-786-4683
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007791101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional