Individual
MS. ANDREA NICOLE BENNERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-A
Contact information
Practice address
200 TARPON TRL, JACKSONVILLE, NC 28546-5287
(910) 938-1114
(910) 938-1118
Mailing address
200 TARPON TRL, JACKSONVILLE, NC 28546-5287
(910) 938-1114
(910) 938-1118
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
NC
Enumeration date
09/07/2017
Last updated
07/21/2022
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