Provider Demographics
NPI:1801996996
Name:MEADOWS, BONNA DANIELS
Entity type:Individual
Prefix:MS
First Name:BONNA
Middle Name:DANIELS
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 S. CROATAN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-1685
Mailing Address - Country:US
Mailing Address - Phone:252-441-9400
Mailing Address - Fax:252-441-3366
Practice Address - Street 1:2514 S. CROATAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-1685
Practice Address - Country:US
Practice Address - Phone:252-441-9400
Practice Address - Fax:252-441-3366
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0019431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12761OtherBC/BS
NC6003406Medicaid
NC6003406Medicaid