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NPI Code Detail

MEDICARE: MS. LAN L BONNO LEBOZEC LPC.,CRC.,CFAE

MEDICARE: MS. LAN L BONNO LEBOZEC LPC.,CRC.,CFAE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor25349SC
2101YP2500XProfessional Counselor3547NC

General Provider Information

NPI Number : 1073696316
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LAN L BONNO LEBOZEC LPC.,CRC.,CFAE
Provider Business Mailing Address
First Line : 237 KING CHARLES RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29209-2241
Country : US
Telephone Number : 803-776-3767
Fax Number :
Provider Business Practice Location Address
First Line : 2015 MARION ST
Second Line : ADULT CLINIC SERVICES
City : COLUMBIA
State : SC
Zip : 29201-2113
Country : US
Telephone Number : 803-898-0276
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 09/11/2025

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