Bonnie J Cundiff, LPC – Professional Counselor

Key facts

NPI: 1619089729
Entity type: Individual (NPI type 1)
Primary specialty: Professional Counselor 101YP2500X
License: 3575 (SC)
Practice address: 207 Commerce Ave
Chesterfield, SC 29709
Phone: (843) 623-2229
Fax: (843) 623-2553
NPI assigned: Aug 31, 2006
Sex: Female
Sole proprietor: No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

South Carolina Dept of Mental Health Accounting Office Community/Behavioral Health Agency · Columbia, SC · NPI 1083421994

NPD (past)
South Carolina Dept of Mental Health Accounting Office Mental Health Clinic/Center (Including Community Mental Health Center) · Bennetsville, SC · NPI 1609979640

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
3575	SC	MD	Professional Counselor

Practice roles

Organization	Specialty	Status	New patients
South Carolina Dept of Mental Health Accounting Office		Past	Accepting new patients
South Carolina Dept of Mental Health Accounting Office		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Professional Counselor	101YP2500X	3575	SC	Yes

Addresses

Primary practice location

207 Commerce Ave
Chesterfield, SC 29709

Mailing address

PO Box 471
Chesterfield, SC 29709
Phone (843) 623-2229

Other identifiers

Identifier	Type	State	Issuer
405127	Medicaid	SC

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619089729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 471",
            "city": "CHESTERFIELD",
            "state": "SC",
            "postal_code": "29709",
            "telephone_number": "843-623-2229",
            "fax_number": "843-623-2553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 COMMERCE AVE",
            "city": "CHESTERFIELD",
            "state": "SC",
            "postal_code": "29709",
            "telephone_number": "843-623-2229",
            "fax_number": "843-623-2553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUNDIFF",
        "first_name": "BONNIE",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "3575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "405127",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, SC

All providers in Chesterfield, SC · Professional Counselor in South Carolina

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.