Individual
JESSE THOMAS BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCASA
Contact information
Practice address
3209 GRESHAM LAKE RD STE 113, RALEIGH, NC 27615-4131
(919) 977-5993
Mailing address
3209 GRESHAM LAKE RD STE 113, RALEIGH, NC 27615-4131
(919) 977-5993
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
25008
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
25008
—
NC
Enumeration date
01/23/2023
Last updated
04/26/2026
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