Provider Demographics
NPI:1003949769
Name:HOLIDAY, BONNIE KAE-MACDUFF (LMSW, ACSW)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:KAE-MACDUFF
Last Name:HOLIDAY
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1582
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49204-1582
Mailing Address - Country:US
Mailing Address - Phone:517-784-3730
Mailing Address - Fax:517-764-4596
Practice Address - Street 1:2301 E MICHIGAN AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3700
Practice Address - Country:US
Practice Address - Phone:517-784-3730
Practice Address - Fax:517-764-4596
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2012-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010667741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical