Provider Demographics
NPI:1073189189
Name:BENNETT, CAROL C (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:C
Last Name:BENNETT
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 1:407 FOXWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-3996
Mailing Address - Country:US
Mailing Address - Phone:910-612-4985
Mailing Address - Fax:
Practice Address - Street 1:407 FOXWOOD LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-3996
Practice Address - Country:US
Practice Address - Phone:910-612-4985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-29
Last Update Date:2021-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0045091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical