Provider Demographics
NPI:1386787752
Name:BENNETT, SANDRA UNDERWOOD (LPC, LMFT)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:UNDERWOOD
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CLOISTER CT STE E
Mailing Address - Street 2:CENTER FOR PSYCHOLOGICAL AND FAMILY SERVICES
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2207
Mailing Address - Country:US
Mailing Address - Phone:919-408-3212
Mailing Address - Fax:919-408-3306
Practice Address - Street 1:101 CLOISTER CT STE E
Practice Address - Street 2:CENTER FOR PSYCHOLOGICAL AND FAMILY SERVICES
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2207
Practice Address - Country:US
Practice Address - Phone:919-408-3212
Practice Address - Fax:919-408-3306
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPSYCHOANALYST101Y00000X
NC802101YP2500X
NC610106H00000X
CAMFC31084106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCLMFT #610OtherLICENSED MARRIAGE FAMILY
CAMFC #31084OtherLICENSED MARRIAGE CHILD C
NCLPC #802OtherLICENSED PROFESSIONAL COU