Provider Demographics
NPI:1740965490
Name:BONHAM, DARRA (LICSW)
Entity type:Individual
Prefix:
First Name:DARRA
Middle Name:
Last Name:BONHAM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2244
Mailing Address - Country:US
Mailing Address - Phone:218-264-5949
Mailing Address - Fax:218-265-3771
Practice Address - Street 1:2602 1ST AVE
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2245
Practice Address - Country:US
Practice Address - Phone:218-263-5949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN294691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical