Individual
MRS. CORA SHADE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6517 ANDORA DR, CHARLOTTE, NC 28227-8072
(704) 568-0872
Mailing address
6517 ANDORA DR, CHARLOTTE, NC 28227-8072
(704) 568-0872
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C003598
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6002600
—
NC
Enumeration date
03/21/2009
Last updated
03/21/2009
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