Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | AP00942429 | WV |
NPI | 1003483652 |
---|---|
Provider Name | Melissa Ann Bennett |
First Address | Princeton, WV 24740 |
Second Address | Princeton, WV 24740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2021 |
Last Update Date | 10/06/2021 |