MEDICARE: SKYE LORREN BENNETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0704016477	VA
2	101YM0800X	Mental Health Counselor	0701015228	VA

General Provider Information

NPI Number	:	1881455194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SKYE LORREN BENNETT

Provider Business Mailing Address
First Line	:	453 CARLISLE DR STE B
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20170-5611
Country	:	US
Telephone Number	:	202-596-8303
Fax Number	:

Provider Business Practice Location Address
First Line	:	4155 CHAIN BRIDGE RD
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-4102
Country	:	US
Telephone Number	:	703-672-1474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2024
Last Update Date	:	08/22/2025

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Directions to “ SKYE LORREN BENNETT ” Practice Location

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