Individual
DASHAIRA KEYANNA BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW-C
Contact information
Practice address
5528 PELHAM AVENUE, BALTIMORE, MD 21206
(443) 220-7296
Mailing address
802 MELVILLE AVE, BALTIMORE, MD 21218-2555
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
18398
MD
1041C0700X
Clinical Social Worker
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
93-3042861
SOLE PROPRIETORSHIP
MD
Enumeration date
02/09/2023
Last updated
09/18/2023
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