Provider Demographics
NPI:1548905037
Name:BENNETT, KIERRA RENEE (LCSW-A)
Entity type:Individual
Prefix:
First Name:KIERRA
Middle Name:RENEE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 TOKEN HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9483
Mailing Address - Country:US
Mailing Address - Phone:832-792-7285
Mailing Address - Fax:
Practice Address - Street 1:166 TOKEN HOUSE RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-9483
Practice Address - Country:US
Practice Address - Phone:832-792-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP017926OtherNC SOCIAL WORK LICENSE