Provider Demographics
NPI:1073753653
Name:KESSLER, BONNIE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:L
Last Name:KESSLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 NORMAN PL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6079
Mailing Address - Country:US
Mailing Address - Phone:404-579-8432
Mailing Address - Fax:864-568-7282
Practice Address - Street 1:439 CONGAREE RD STE 10
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2868
Practice Address - Country:US
Practice Address - Phone:864-735-0662
Practice Address - Fax:864-568-7282
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY 002463103TA0700X, 103TB0200X, 103TC0700X, 103TC1900X, 103TP0814X, 103TP2701X
SC1405103TH0004X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy