Provider Demographics
NPI:1538247861
Name:DUNLAP, BRUCE ALLEN
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ALLEN
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 LAKE SHIRE DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-3042
Mailing Address - Country:US
Mailing Address - Phone:803-606-3570
Mailing Address - Fax:
Practice Address - Street 1:1109 LAKE SHIRE DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-3042
Practice Address - Country:US
Practice Address - Phone:803-606-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCWP9901Medicaid