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General NPI Number Information
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NPI Number | 1881455194
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Entity Type | Individual
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Provider Name | SKYE LORREN BENNETT
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Gender | Female
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 4155 CHAIN BRIDGE RD
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City | FAIRFAX
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State | VA
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Zip | 22030-4102
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Country | US
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Telephone | 703-672-1474
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Fax |
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Provider Business Mailing Address
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Address Line | 453 CARLISLE DR STE B
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City | HERNDON
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State | VA
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Zip | 20170-5611
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Country | US
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Telephone | 202-596-8303
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0704016477
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701015228
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License Number State | VA
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