Provider Demographics
NPI:1225281751
Name:BONDURANT, TAMMI (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:
Last Name:BONDURANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W STRONG ST
Mailing Address - Street 2:SUITE 30B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-3164
Mailing Address - Country:US
Mailing Address - Phone:850-433-0110
Mailing Address - Fax:850-433-0188
Practice Address - Street 1:15 W STRONG ST
Practice Address - Street 2:SUITE 30B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3164
Practice Address - Country:US
Practice Address - Phone:850-433-0110
Practice Address - Fax:850-433-0188
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW9049104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker