Provider Demographics
NPI:1275233132
Name:BENNETT, CASEY MILES (LCPC)
Entity Type:Individual
Prefix:MR
First Name:CASEY
Middle Name:MILES
Last Name:BENNETT
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9414 BELAIR RD STE 201
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1542
Mailing Address - Country:US
Mailing Address - Phone:410-529-2151
Mailing Address - Fax:
Practice Address - Street 1:9414 BELAIR RD STE 201
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-1542
Practice Address - Country:US
Practice Address - Phone:410-529-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC14101101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional