Provider Demographics
NPI:1952930752
Name:BON-WILSON, ANDREA LEA (LPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEA
Last Name:BON-WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 S KRAMERIA WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2138
Mailing Address - Country:US
Mailing Address - Phone:303-882-0223
Mailing Address - Fax:
Practice Address - Street 1:1711 S KRAMERIA WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-2138
Practice Address - Country:US
Practice Address - Phone:720-321-8312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004988101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional