Provider Demographics
NPI:1962633008
Name:COMPTON, BONNIE (APRN, BC, CPNP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:COMPTON
Suffix:
Gender:F
Credentials:APRN, BC, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2948 SEABROOK ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-6221
Mailing Address - Country:US
Mailing Address - Phone:843-566-5070
Mailing Address - Fax:888-889-2390
Practice Address - Street 1:3030 ASHLEY TOWN CENTER DR
Practice Address - Street 2:SUITE B-203
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5664
Practice Address - Country:US
Practice Address - Phone:843-735-5900
Practice Address - Fax:843-735-7323
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3936101YM0800X
MDAC000726101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health