Provider Demographics
NPI:1881852515
Name:BONNELL, VICTORIA ANN (LISW-CP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:BONNELL
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CLARK SUMMIT DR
Mailing Address - Street 2:SUITE F201
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4205
Mailing Address - Country:US
Mailing Address - Phone:843-757-4737
Mailing Address - Fax:843-757-4585
Practice Address - Street 1:25 CLARK SUMMIT DR
Practice Address - Street 2:F201
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4205
Practice Address - Country:US
Practice Address - Phone:843-757-4737
Practice Address - Fax:843-757-4585
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC81921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical