Provider Demographics
NPI:1437163185
Name:BENNETT, CAROLE (PHD,RN,CS)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHD,RN,CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4345
Mailing Address - Country:US
Mailing Address - Phone:843-884-7710
Mailing Address - Fax:843-884-7710
Practice Address - Street 1:208 SCOTT ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4345
Practice Address - Country:US
Practice Address - Phone:843-884-7710
Practice Address - Fax:843-884-7710
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16912101YM0800X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health