Provider Demographics
NPI:1013522655
Name:BENNETT, MORGAN RAE (LMFTA)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:RAE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 CULPEPPER LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1755
Mailing Address - Country:US
Mailing Address - Phone:910-262-0863
Mailing Address - Fax:
Practice Address - Street 1:2301 STONEHENGE DR STE 110
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4379
Practice Address - Country:US
Practice Address - Phone:910-262-0863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12232A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist