Provider Demographics
NPI:1265957591
Name:HENNIG-TRESTMAN, BONNIE LYNN (LCSW)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:LYNN
Last Name:HENNIG-TRESTMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:LYNN
Other - Last Name:HENNIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DSW
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 RIVERSIDE CIR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4955
Practice Address - Country:US
Practice Address - Phone:540-224-5170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002932104100000X
VA01040101221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker