Provider Demographics
NPI:1811202120
Name:GLENN, BONNIE L (LPC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:GLENN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:LEIGH
Other - Last Name:CRAVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:37 W FAIRMONT AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3457
Mailing Address - Country:US
Mailing Address - Phone:912-661-2801
Mailing Address - Fax:800-615-5428
Practice Address - Street 1:37 W FAIRMONT AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3457
Practice Address - Country:US
Practice Address - Phone:912-661-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional