Provider Demographics
NPI:1710134150
Name:GUNTHER, BRUCE ADIN (MS,MSW,)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ADIN
Last Name:GUNTHER
Suffix:
Gender:M
Credentials:MS,MSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 ETTERS LN
Mailing Address - Street 2:
Mailing Address - City:CASSATT
Mailing Address - State:SC
Mailing Address - Zip Code:29032-9265
Mailing Address - Country:US
Mailing Address - Phone:803-425-7178
Mailing Address - Fax:
Practice Address - Street 1:1645 ETTERS LN
Practice Address - Street 2:
Practice Address - City:CASSATT
Practice Address - State:SC
Practice Address - Zip Code:29032-9265
Practice Address - Country:US
Practice Address - Phone:803-425-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8973 CP-S1041C0700X
RILICSW 2091041C0700X
RILIMFT 23 (INACTIVE)106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist