Provider Demographics
NPI:1366596058
Name:PHILLIPS, BONNIE ELAINE (MFT)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:ELAINE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 BEARBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3241
Mailing Address - Country:US
Mailing Address - Phone:714-624-0399
Mailing Address - Fax:
Practice Address - Street 1:1550 HENDERSONVILLE RD STE 202
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3245
Practice Address - Country:US
Practice Address - Phone:828-351-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46460106H00000X
NC2532106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist