Provider Demographics
NPI:1891549150
Name:SMITH, BONNIE JEAN (MSW, PHD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 RED ROCK LN
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-5483
Mailing Address - Country:US
Mailing Address - Phone:864-275-5731
Mailing Address - Fax:
Practice Address - Street 1:110 RED ROCK LN
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-5483
Practice Address - Country:US
Practice Address - Phone:864-275-5731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4987104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker