Provider Demographics
NPI:1598132607
Name:BENNETT, TONYA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:TONYA
Other - Middle Name:N
Other - Last Name:GIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1832 KEMPSVILLE RD STE 112
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6861
Mailing Address - Country:US
Mailing Address - Phone:757-354-1207
Mailing Address - Fax:
Practice Address - Street 1:1832 KEMPSVILLE RD STE 112
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6861
Practice Address - Country:US
Practice Address - Phone:757-354-1207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040090931041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical