Self, Bonatia

Self, Bonatia is an individual health care provider with primary practice located at 306 Airport Dr , Moncks Corner SC 29461-2629. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Self, Bonatia can be contacted via phone (843) 761-8272.

Contact Information

Primary practice address
306 Airport Dr Moncks Corner SC 29461-2629
Phone: (843) 761-8272
Fax: (843) 719-3025
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X

Profile Details

NPI number 1902568652
LBN Legal business name Self, Bonatia
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 11th, 2021
Last updated Oct 11th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902568652 NPPES
South Carolina MEDICAID 571048948

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