Provider Demographics
NPI:1366860132
Name:BONESTEEL, THERESA (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:BONESTEEL
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3039 LEAPHART RD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3050
Mailing Address - Country:US
Mailing Address - Phone:803-465-5576
Mailing Address - Fax:803-753-9578
Practice Address - Street 1:3039 LEAPHART RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3050
Practice Address - Country:US
Practice Address - Phone:803-465-5576
Practice Address - Fax:803-753-9578
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2023-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1534Medicaid