Provider Demographics
NPI:1447490735
Name:BONAPART, THADIUS LEONARD III
Entity type:Individual
Prefix:MR
First Name:THADIUS
Middle Name:LEONARD
Last Name:BONAPART
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 BAXTER ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3067
Mailing Address - Country:US
Mailing Address - Phone:704-777-5705
Mailing Address - Fax:
Practice Address - Street 1:1339 BAXTER ST STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3067
Practice Address - Country:US
Practice Address - Phone:704-777-5705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst