Provider Demographics
NPI:1033777982
Name:BENNETT, CARLA MICHELLE (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:MICHELLE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 DIVISION AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403
Mailing Address - Country:US
Mailing Address - Phone:253-403-9200
Mailing Address - Fax:253-403-9201
Practice Address - Street 1:1105 DIVISION AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403
Practice Address - Country:US
Practice Address - Phone:253-403-9200
Practice Address - Fax:253-403-9201
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC001023170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS