Individual
ADERA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1050 CONNECTICUT AVE NW STE 500, WASHINGTON, DC 20036-5304
(980) 200-4540
Mailing address
1215 BASSWOOD CT, CHESAPEAKE, VA 23320-5102
(980) 200-4540
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-181685
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-21-181685
RBT CERTIFICATION
—
Enumeration date
10/18/2021
Last updated
10/18/2021
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