Individual
DR. BERT BENNETT III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3111 MAPLEWOOD AVE, SUITE 105, WINSTON-SALEM, NC 27103-3906
(336) 624-6412
(336) 724-3839
Mailing address
1684 CHICKASHA DR, PFAFFTOWN, NC 27040-8210
(336) 638-1812
(336) 946-1075
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1361
NC
103TC1900X
Counseling Psychologist
1361
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6000742
—
NC
Enumeration date
06/12/2006
Last updated
06/07/2021
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