Individual
JACQUELINE NICHOLE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
780 GREGG ST, WASHINGTON COURT HOUSE, OH 43160-1564
(740) 313-7513
Mailing address
110 HIGHLAND AVE, CIRCLEVILLE, OH 43113-1208
(740) 477-1745
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.164571
OH
Other
Enumeration date
04/24/2018
Last updated
04/24/2018
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