Provider Demographics
NPI:1255172821
Name:BENNETT, KRISTA SAAB (MA, NCC, NCMHCA)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:SAAB
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MA, NCC, NCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 SILVER ELM LN
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-4408
Mailing Address - Country:US
Mailing Address - Phone:818-445-6432
Mailing Address - Fax:
Practice Address - Street 1:4030 WAKE FOREST RD STE 206
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6800
Practice Address - Country:US
Practice Address - Phone:919-713-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20069101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health