Individual
DEMETRIA BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 W MAIN ST STE D, ALBEMARLE, NC 28001-5446
(704) 982-4068
Mailing address
2000 W MAIN ST STE D, ALBEMARLE, NC 28001-5446
(704) 982-4068
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/19/2016
Last updated
01/19/2016
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