Healthcare Provider Details

I. General information

NPI: 1962633008
Provider Name (Legal Business Name): BONNIE COMPTON APRN, BC, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 ASHLEY TOWN CENTER DR SUITE B-203
CHARLESTON SC
29414-5664
US

IV. Provider business mailing address

2948 SEABROOK ISLAND RD
JOHNS ISLAND SC
29455-6221
US

V. Phone/Fax

Practice location:
  • Phone: 843-735-5900
  • Fax: 843-735-7323
Mailing address:
  • Phone: 843-566-5070
  • Fax: 888-889-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3936
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAC000726
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: