Provider Demographics
NPI:1114963865
Name:BENNER, KATHERINE SUE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SUE
Last Name:BENNER
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 1:4920 E MILLRIDGE PARKWAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23112
Mailing Address - Country:US
Mailing Address - Phone:804-622-5350
Mailing Address - Fax:804-622-5350
Practice Address - Street 1:4920 E MILLRIDGE PARKWAY
Practice Address - Street 2:SUITE 220
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23112
Practice Address - Country:US
Practice Address - Phone:804-622-5350
Practice Address - Fax:804-622-5350
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA17731015OtherAETNA PROVIDER NUMBER
VA341121OtherUNITED BEHAVIORAL HEALTH
VA954796OtherCOMPSYCH
VA289622OtherANTHEM
VA87854MOtherSENTARA