Provider Demographics
NPI:1629753462
Name:BENNETT, JANINE MICHELLE (CAC I)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:MICHELLE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 JEFFERSON ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2642
Mailing Address - Country:US
Mailing Address - Phone:202-276-3152
Mailing Address - Fax:
Practice Address - Street 1:1320 GOOD HOPE RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6912
Practice Address - Country:US
Practice Address - Phone:202-610-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCACI1097101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)