Provider Demographics
NPI:1982719035
Name:GARNETTE, BONNIE GORE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:GORE
Last Name:GARNETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6418 ECKHERT RD
Mailing Address - Street 2:APT # 4202
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2896
Mailing Address - Country:US
Mailing Address - Phone:225-405-1992
Mailing Address - Fax:
Practice Address - Street 1:7400 MERTON MINTER BLVD.
Practice Address - Street 2:SOUTH TEXAS VETERANS HEALTH CARE SYSTEM
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-617-5300
Practice Address - Fax:210-949-3326
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA62071041C0700X
NCC0055261041C0700X
SC94081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9408OtherSTATE BOARD OF SOCIAL WORK LICENSURE
NCC005526OtherSTATE BOARD OF SOCIAL WORK LICENSURE
LA6207OtherSTATE BOARD OF SOCIAL WORK LICENSURE