Doctor Name: | MARCIA BONAHOOM |
NPI Number: | 1033308606 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. |
License Number: | 6301010140 |
Business Practice Address: | 16824 Kercheval Pl Grosse Pointe, MI - 482301500 |
Business Phone Number: | 3138822150 |
Business Fax Number: | |
Mailing Address: | 16824 Kercheval Pl, GROSSE POINTE |
State: | MI |
Postal Code: | 482301500 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/19/2007 |
NPI Last Update Date: | 10/19/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TB0200X |
License Number: | 6301010140 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Cognitive & Behavioral |
Taxonomy Definition: |