Provider Demographics
NPI:1801005459
Name:COOLEY, BONITA TYNDALL (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:BONITA
Middle Name:TYNDALL
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 N SPENCE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4354
Mailing Address - Country:US
Mailing Address - Phone:919-583-8448
Mailing Address - Fax:919-583-8449
Practice Address - Street 1:696 N SPENCE AVE STE B
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4354
Practice Address - Country:US
Practice Address - Phone:919-583-8448
Practice Address - Fax:919-583-8449
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2992101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health