Provider Demographics
NPI:1023260379
Name:DAVIS, BONNIE MARIE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:BONNIE
Other - Middle Name:R
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:435 HOMER RD
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-2933
Mailing Address - Country:US
Mailing Address - Phone:318-371-3001
Mailing Address - Fax:318-371-3300
Practice Address - Street 1:435 HOMER RD
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-2933
Practice Address - Country:US
Practice Address - Phone:318-371-3001
Practice Address - Fax:318-371-3300
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical