Provider Demographics
NPI:1073696316
Name:BONNO LEBOZEC, LAN L (LPC,CRC,CFAE)
Entity Type:Individual
Prefix:MS
First Name:LAN
Middle Name:L
Last Name:BONNO LEBOZEC
Suffix:
Gender:F
Credentials:LPC,CRC,CFAE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 KING CHARLES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-2241
Mailing Address - Country:US
Mailing Address - Phone:803-776-3767
Mailing Address - Fax:
Practice Address - Street 1:2015 MARION ST
Practice Address - Street 2:ADULT CLINIC SERVICES
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2113
Practice Address - Country:US
Practice Address - Phone:803-898-0276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25349101YA0400X
NC3547101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional