Provider Demographics
NPI:1154682821
Name:BENNETT, DONNA BOWERS (LCSW-C)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:BOWERS
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1323
Mailing Address - Street 2:22525 WASHINGTON ST STE 1A
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-1323
Mailing Address - Country:US
Mailing Address - Phone:240-538-2577
Mailing Address - Fax:888-974-6528
Practice Address - Street 1:22525 WASHINGTON ST
Practice Address - Street 2:STE 1A
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3899
Practice Address - Country:US
Practice Address - Phone:240-538-2577
Practice Address - Fax:888-974-6528
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD093121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical