Diane Bonilla, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701002334 Issued in VA

Practice address

5045 Backlick Road
Annandale, VA 22003

Phone

(703) 914-1082

NPI assigned

Jul 31, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• New Horizons Psychological Services Inc

  • Clinical Psychologist
  • Annandale, VA
  • NPI 1982792917
  NPD (past)
• New Horizons Psychological Services LLC

  • Clinical Child & Adolescent Psychologist
  • Fort Washington, MD
  • NPI 1053403386
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407862857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 DOGWOOD DR",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223022724",
            "telephone_number": "703-578-0958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5045 BACKLICK ROAD",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "22003",
            "telephone_number": "703-914-1082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONILLA",
        "first_name": "DIANE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701002334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• BMR-3 VA, LLC (American Senior Care)
• Body Kinetics Rehab LLC.
• Body Mechanix and Beyond LLC
• Kelly Bojan, RIC, PLPC
• Jae Kwon Bok
• Hugo A Bonilla, DDS, MS
• Amanda Boostrom, RDN
• Born Acupuncture
• Ana Maria Born, MD
• Elizabeth Mary Bostwick, FNP

• Professional Counselor in Annandale, VA
• Providers in Annandale, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.