Jackson-Vergara, Bonita Marie

Jackson-Vergara, Bonita Marie is an sole proprietor health care provider with primary practice located at 1545 Crossways Blvd Ste 250 , Chesapeake VA 23320-0218. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Jackson-Vergara, Bonita Marie can be contacted via phone (704) 804-9614.

Contact Information

Primary practice address
1545 Crossways Blvd Ste 250 Chesapeake VA 23320-0218
Phone: (704) 804-9614
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 0718000386 Virginia
Behavioral Health & Social Service Providers / Professional 101YP2500X 0701005902 Virginia
Behavioral Health & Social Service Providers / Professional 101YP2500X 4804 North Carolina

Profile Details

NPI number 1316967334
LBN Legal business name Jackson-Vergara, Bonita Marie
Credentials LICENSED COUNSELOR
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 20th, 2006
Last updated Oct 13th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316967334 NPPES
North Carolina MEDICAID 6103317

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