Provider Demographics
NPI:1164659116
Name:BENNETT, MELISSIA ANNETTA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MELISSIA
Middle Name:ANNETTA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 UNIVERSITY EAST DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4100
Mailing Address - Country:US
Mailing Address - Phone:704-756-9746
Mailing Address - Fax:
Practice Address - Street 1:8815 UNIVERSITY EAST DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4100
Practice Address - Country:US
Practice Address - Phone:704-756-9746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7438101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional