Provider Demographics
NPI:1982390043
Name:BENTLEY, TAMMY (LPC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:BENTLEY
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 1:5416 SHARP ACORN CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-5400
Mailing Address - Country:US
Mailing Address - Phone:616-822-9547
Mailing Address - Fax:
Practice Address - Street 1:5416 SHARP ACORN CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-5400
Practice Address - Country:US
Practice Address - Phone:616-822-9547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008682101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor