Provider Demographics
NPI:1568725463
Name:BENNETT, FELICIA (LGSW)
Entity Type:Individual
Prefix:MISS
First Name:FELICIA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SOMMERSET DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36869-5709
Mailing Address - Country:US
Mailing Address - Phone:334-520-7319
Mailing Address - Fax:
Practice Address - Street 1:14 SOMMERSET DR
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36869-5709
Practice Address - Country:US
Practice Address - Phone:334-520-7319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-17
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
AL4484B104100000X, 251B00000X, 251S00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health