Provider Demographics
NPI:1386226330
Name:BENNETT, NANCY (LPC)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4887 OLD MANSION RD
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23952-2107
Mailing Address - Country:US
Mailing Address - Phone:434-264-2610
Mailing Address - Fax:
Practice Address - Street 1:350 POPLAR DR
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9367
Practice Address - Country:US
Practice Address - Phone:804-733-6874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010457101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health