Provider Demographics
NPI:1295971927
Name:BUMGARNER, GLENDA GAIL (MDIV, LMFT)
Entity type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:GAIL
Last Name:BUMGARNER
Suffix:
Gender:F
Credentials:MDIV, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 GROCE RD
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-1761
Mailing Address - Country:US
Mailing Address - Phone:864-439-7760
Mailing Address - Fax:
Practice Address - Street 1:84 GROCE RD
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365-1761
Practice Address - Country:US
Practice Address - Phone:864-439-7760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4480106H00000X
NC1164106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist