Provider Demographics
NPI:1861886970
Name:BENNETT, PEGGY LYNETTE (LCSWA)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:LYNETTE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 JA LILLY DR
Mailing Address - Street 2:
Mailing Address - City:VANCEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28586-7501
Mailing Address - Country:US
Mailing Address - Phone:252-214-0893
Mailing Address - Fax:
Practice Address - Street 1:221 JA LILLY DR
Practice Address - Street 2:
Practice Address - City:VANCEBORO
Practice Address - State:NC
Practice Address - Zip Code:28586-7501
Practice Address - Country:US
Practice Address - Phone:252-633-3855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0094241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical