Provider Demographics
NPI:1629958616
Name:BONA, MOMOH AUGUSTINE (RBT, DSP, HHA)
Entity type:Individual
Prefix:
First Name:MOMOH
Middle Name:AUGUSTINE
Last Name:BONA
Suffix:
Gender:M
Credentials:RBT, DSP, HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 DANUBE LN APT 703
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1854
Mailing Address - Country:US
Mailing Address - Phone:408-831-8727
Mailing Address - Fax:
Practice Address - Street 1:4801 DANUBE LN APT 703
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1854
Practice Address - Country:US
Practice Address - Phone:408-831-8727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-03
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC172A00000X, 374T00000X, 385HR2055X, 172V00000X, 374K00000X, 385H00000X, 372600000X, 385HR2060X
374U00000X
NCRBT-24-392496106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No172A00000XOther Service ProvidersDriverGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health Aide
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No172V00000XOther Service ProvidersCommunity Health Worker
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No385H00000XRespite Care FacilityRespite Care
No372600000XNursing Service Related ProvidersAdult Companion
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child