Provider Demographics
NPI:1780307207
Name:RAUCH-BOUIE, BONNIE F (LPC-A)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:F
Last Name:RAUCH-BOUIE
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N DONAR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-6589
Mailing Address - Country:US
Mailing Address - Phone:803-348-7101
Mailing Address - Fax:
Practice Address - Street 1:1950 BUSH RIVER RD STE 4
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-6800
Practice Address - Country:US
Practice Address - Phone:803-760-7449
Practice Address - Fax:803-636-2637
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional