Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LH00005977 | WA |
NPI | 1003098682 |
---|---|
Provider Name | Ms. Sarah Lisa Bennett |
First Address | Tacoma, WA 98405-2441 |
Second Address | Tacoma, WA 98406-6202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2007 |
Last Update Date | 28/05/2010 |