Provider Demographics
NPI:1285302398
Name:BENNER, ANN BOHR (LCSW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:BOHR
Last Name:BENNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 VUE AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-3261
Mailing Address - Country:US
Mailing Address - Phone:434-760-0354
Mailing Address - Fax:
Practice Address - Street 1:3027 VUE AVE APT 107
Practice Address - Street 2:
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-3261
Practice Address - Country:US
Practice Address - Phone:434-760-0354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904004867101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty