Provider Demographics
NPI:1932808433
Name:BONNY, BRIDGET (RBT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:BONNY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 SUGAR VALLEY TRL SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3826
Mailing Address - Country:US
Mailing Address - Phone:404-944-1094
Mailing Address - Fax:
Practice Address - Street 1:2251 HIGHWAY 42 N
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4735
Practice Address - Country:US
Practice Address - Phone:770-865-7722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-21-189591106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician