Provider Demographics
NPI:1245494459
Name:BONNER, EBONY NICOLE (LMHC)
Entity type:Individual
Prefix:MS
First Name:EBONY
Middle Name:NICOLE
Last Name:BONNER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:EBONY
Other - Middle Name:NICOLE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:4310 METRO PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9416
Mailing Address - Country:US
Mailing Address - Phone:239-236-8784
Mailing Address - Fax:239-790-2624
Practice Address - Street 1:16578 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1325
Practice Address - Country:US
Practice Address - Phone:813-412-5504
Practice Address - Fax:813-412-5525
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9497101YM0800X
FLMH9497101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health