Provider Demographics
NPI:1356035646
Name:BENNETT, ASIA BRIANNA (LCSW)
Entity type:Individual
Prefix:
First Name:ASIA
Middle Name:BRIANNA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ASIA
Other - Middle Name:BRIANNA
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1414 LOST CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3662
Mailing Address - Country:US
Mailing Address - Phone:214-606-3988
Mailing Address - Fax:
Practice Address - Street 1:8350 N CENTRAL EXPY STE 1900
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-1604
Practice Address - Country:US
Practice Address - Phone:512-649-1986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX641061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty