Provider Demographics
NPI:1043003791
Name:BENNETT, PORTIA LEIGH (LPC)
Entity type:Individual
Prefix:
First Name:PORTIA
Middle Name:LEIGH
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LUNESFORD CT APT 403
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7148
Mailing Address - Country:US
Mailing Address - Phone:540-645-3582
Mailing Address - Fax:540-645-3582
Practice Address - Street 1:1745 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7213
Practice Address - Country:US
Practice Address - Phone:540-288-5245
Practice Address - Fax:540-288-5294
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701014894101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional