Provider Demographics
NPI:1639052251
Name:BONNER, MICAH (MA, LADAC-II)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:BONNER
Suffix:
Gender:M
Credentials:MA, LADAC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 OLDE COLONY TRL APT 11
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-6227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:980 W HIGHWAY 25 70
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-9006
Practice Address - Country:US
Practice Address - Phone:865-805-0567
Practice Address - Fax:423-205-4023
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)