Provider Demographics
NPI:1871562264
Name:BONNER-BRITT, CONSTANCE MARLENE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:MARLENE
Last Name:BONNER-BRITT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4406
Mailing Address - Country:US
Mailing Address - Phone:360-542-6895
Mailing Address - Fax:866-492-5137
Practice Address - Street 1:924 S 11TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4406
Practice Address - Country:US
Practice Address - Phone:360-542-6895
Practice Address - Fax:866-492-5137
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00009182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00009182OtherMENTAL HEALTH LICENSE NUM