Provider Demographics
NPI:1295154201
Name:BONGAERTS, CELINE (LPC)
Entity type:Individual
Prefix:
First Name:CELINE
Middle Name:
Last Name:BONGAERTS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5269 US HIGHWAY 158
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-6905
Mailing Address - Country:US
Mailing Address - Phone:336-486-7306
Mailing Address - Fax:336-986-9848
Practice Address - Street 1:5269 US HIGHWAY 158
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-6905
Practice Address - Country:US
Practice Address - Phone:336-486-7306
Practice Address - Fax:336-986-9848
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10088101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3410002Medicaid