Provider Demographics
NPI:1538307061
Name:BENNETT, BEVERLY P (LPC)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:P
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:BEVERLY
Other - Middle Name:P
Other - Last Name:VIRGIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1572
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29679-1572
Mailing Address - Country:US
Mailing Address - Phone:918-219-3123
Mailing Address - Fax:
Practice Address - Street 1:30 PATEWOOD DR STE 160
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6809
Practice Address - Country:US
Practice Address - Phone:843-501-1099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3123101YP2500X
SC8552101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional