Individual
SANDRA LEE WASHINGTON BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, APC
Contact information
Practice address
168 14TH STREET, FAIRFAX, SC 29827
(843) 301-3470
Mailing address
P.O BOX 1456, FAIRFAX, SC 29827
(843) 301-3470
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8497
SC
101YM0800X
Mental Health Counselor
APC009393
GA
Other
Enumeration date
04/08/2024
Last updated
04/08/2024
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