Provider Demographics
NPI:1720735046
Name:HALL, BONI PARKER (LCMHCA)
Entity Type:Individual
Prefix:
First Name:BONI
Middle Name:PARKER
Last Name:HALL
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 KILDARE PL
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2732
Mailing Address - Country:US
Mailing Address - Phone:910-612-0655
Mailing Address - Fax:
Practice Address - Street 1:108 GILES AVE STE 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4759
Practice Address - Country:US
Practice Address - Phone:910-769-9691
Practice Address - Fax:910-239-8373
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health