Provider Demographics
NPI:1497508790
Name:WASHINGTON BENNETT, SANDRA LEE (MA, APC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:WASHINGTON BENNETT
Suffix:
Gender:F
Credentials:MA, APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 1456
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:SC
Mailing Address - Zip Code:29827
Mailing Address - Country:US
Mailing Address - Phone:843-301-3470
Mailing Address - Fax:
Practice Address - Street 1:168 14TH STREET
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:SC
Practice Address - Zip Code:29827
Practice Address - Country:US
Practice Address - Phone:843-301-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8497101YM0800X
GAAPC009393101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health