Provider Demographics
NPI:1093155566
Name:BENNETT, SARA LIGHT (LPC, CADC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LIGHT
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPC, CADC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LIGHT
Other - Last Name:JEFFERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1720 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4047
Mailing Address - Country:US
Mailing Address - Phone:208-746-4097
Mailing Address - Fax:208-746-2294
Practice Address - Street 1:1720 18TH AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4047
Practice Address - Country:US
Practice Address - Phone:208-746-4097
Practice Address - Fax:208-746-2294
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID10073101YA0400X
IDLPC-3973101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)