Provider Information for 1336790633
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Mrs. JENNA BONNELL CANTERBURY LCSW
Sex: Female
NPI: 1336790633
Last Updated: 2023-04-16
Certification Date: 2023-04-16
Certification Date: 2023-04-16
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1336790633 | ||||||||||||
| Enumeration Date | 2019-09-27 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 926 CLEVELAND ST APT 4208 GREENVILLE, SC 29601-4651 United States Phone: 229-560-6009 | Fax: | ||||||||||||
| Primary Practice Address | 926 CLEVELAND ST APT 4208 GREENVILLE, SC 29601-4651 United States Phone: 229-560-6009 | Fax: | ||||||||||||
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