Provider Demographics
NPI:1477763001
Name:BANKHEAD, RONNA KAY (MA LPC)
Entity type:Individual
Prefix:MISS
First Name:RONNA
Middle Name:KAY
Last Name:BANKHEAD
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W COLEMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3494
Mailing Address - Country:US
Mailing Address - Phone:843-709-0917
Mailing Address - Fax:843-884-5497
Practice Address - Street 1:222 W COLEMAN BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3494
Practice Address - Country:US
Practice Address - Phone:843-709-0917
Practice Address - Fax:843-884-5497
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4652101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional