Healthcare Provider Details

I. General information

NPI: 1346171063
Provider Name (Legal Business Name): MELISSA BENNITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23164 DRAGOON RD
LIGNUM VA
22726-2036
US

IV. Provider business mailing address

9 RAVENSWORTH CT
FREDERICKSBURG VA
22405-2155
US

V. Phone/Fax

Practice location:
  • Phone: 540-423-1736
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016203
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: