Provider Demographics
NPI:1902049117
Name:HOLSTEIN, BONNIE EGLESTON (LISW)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:EGLESTON
Last Name:HOLSTEIN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 MILLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1827
Mailing Address - Country:US
Mailing Address - Phone:803-960-4872
Mailing Address - Fax:803-254-4406
Practice Address - Street 1:3204 MILLWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1827
Practice Address - Country:US
Practice Address - Phone:803-960-4872
Practice Address - Fax:803-254-4406
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical