Healthcare Provider Details

I. General information

NPI: 1073753653
Provider Name (Legal Business Name): BONNIE L KESSLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 CONGAREE RD STE 10
GREENVILLE SC
29607-2868
US

IV. Provider business mailing address

105 NORMAN PL
GREENVILLE SC
29615-6079
US

V. Phone/Fax

Practice location:
  • Phone: 864-735-0662
  • Fax: 864-568-7282
Mailing address:
  • Phone: 404-579-8432
  • Fax: 864-568-7282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY 002463
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY 002463
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 002463
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY 002463
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number1405
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPSY 002463
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY 002463
License Number StateGA
# 8
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1405
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: