Individual provider · NPI-1
Vanessa Bonilla, LAC
Counselor, Mental Health · Hackensack, NJ
NPI number1073204061
StatusActive
Last updated in NPPESMay 19, 2023
Details
- NPI
- 1073204061
- Entity type
- Individual (NPI-1)
- Name
- Vanessa Bonilla
- Credential
- LAC
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 19, 2023
- Certification date
- May 18, 2023
- Last updated
- May 19, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | 37AC00468200 | NJ | Yes |
Practice location
25 E Salem StHackensack, NJ 07601-7427
Phone 201-933-8508
Mailing address
619 Schuyler Ave Apt 102Lyndhurst, NJ 07071-2928
Phone 973-640-0245
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