Provider Demographics
NPI:1013170075
Name:BENNETT, ADRIAN VANTRICE (LPC)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:VANTRICE
Last Name:BENNETT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:ADRIAN
Other - Middle Name:VANTRICE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASE MANAGER/CARE CO
Mailing Address - Street 1:2021 21ST AVE
Mailing Address - Street 2:SUITE C400
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4350
Mailing Address - Country:US
Mailing Address - Phone:615-748-0625
Mailing Address - Fax:615-369-3059
Practice Address - Street 1:2021 21ST AVE
Practice Address - Street 2:SUITE C400
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4350
Practice Address - Country:US
Practice Address - Phone:615-748-0625
Practice Address - Fax:615-369-3059
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3954101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional