MEDICARE: MRS. VADONNA BENSON BARTELL MS, LPC, CACII

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
1	101Y00000X	Counselor	2298	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2298	OTHER	SC	LPC LICENSURE

General Provider Information

NPI Number	:	1841585874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VADONNA BENSON BARTELL MS, LPC, CACII

Provider Business Mailing Address
First Line	:	711 BARTELLS RD
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-7564
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 BARTELLS RD
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-7564
Country	:	US
Telephone Number	:	843-558-2786
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2011
Last Update Date	:	06/17/2011

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