Provider Demographics
NPI:1750394284
Name:BONEY, VIRGINIA M (PHD, LMFT, LMHC)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:M
Last Name:BONEY
Suffix:
Gender:F
Credentials:PHD, LMFT, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8833 PERIMETER PARK BLVD.
Mailing Address - Street 2:STE 701
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-236-3963
Mailing Address - Fax:904-642-2469
Practice Address - Street 1:8833 PERIMETER PARK BLVD.
Practice Address - Street 2:STE 701
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-236-3963
Practice Address - Fax:904-642-2469
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5084101YP2500X
FLMT 1924106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional