1821530908 NPI number — ALEXANDRA CHERE-TRINA BONNER LCSW-A

Table of content: ALEXANDRA CHERE-TRINA BONNER LCSW-A (NPI 1821530908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821530908 NPI number — ALEXANDRA CHERE-TRINA BONNER LCSW-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONNER
Provider First Name:
ALEXANDRA
Provider Middle Name:
CHERE-TRINA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821530908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7505 KINGS RIDGE DR
Provider Second Line Business Mailing Address:
APT 104
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28217-5958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-810-4476
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7505 KINGS RIDGE DR
Provider Second Line Business Practice Location Address:
APT 104
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28217-5958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-810-4476
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  P-011072 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com