Provider Demographics
NPI:1972926772
Name:BONNIE JONES, LCSW-C PSYCHOTHERAPY SERVICES
Entity Type:Organization
Organization Name:BONNIE JONES, LCSW-C PSYCHOTHERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-997-0013
Mailing Address - Street 1:30 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4622
Mailing Address - Country:US
Mailing Address - Phone:240-997-0013
Mailing Address - Fax:
Practice Address - Street 1:30 HICKORY AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4622
Practice Address - Country:US
Practice Address - Phone:240-997-0013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD081401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295813756OtherNATIONAL PROVIDER IDENTIFIER - INDIVIDUAL
MD754248800Medicaid