Provider Demographics
NPI:1003629759
Name:BONNER, GABRI'ELLA (LCSW)
Entity type:Individual
Prefix:
First Name:GABRI'ELLA
Middle Name:
Last Name:BONNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 CRESCENT POINTE PKWY APT 8309
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-7400
Mailing Address - Country:US
Mailing Address - Phone:346-270-6087
Mailing Address - Fax:
Practice Address - Street 1:1550 CRESCENT POINTE PKWY APT 8309
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-7400
Practice Address - Country:US
Practice Address - Phone:346-270-6087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1080121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical