Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 4355 | NC |
Y | 103T00000X | Psychologist | 4355 | NC |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 4355 | NC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 4355 | NC |
N | 103G00000X | Clinical Psychologist | 4355 | NC |
N | 103TC0700X | Clinical Psychologist | 4355 | NC |
N | 103TH0100X | Health Service | 4355 | NC |
N | 103TP2701X | Group Psychotherapist | 4355 | NC |
NPI | 1326391699 |
---|---|
Provider Name | Magdalena Janina Bonk |
First Address | Rocky Point, NC 28457-9452 |
Second Address | Wilmington, NC 28401-7361 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2012 |
Last Update Date | 23/10/2012 |