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General NPI Number Information
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NPI Number | 1902955503
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Entity Type | Individual
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Provider Name | STACIE CAMP BENNETT MA, LPC
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Gender | Male
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 809 N LAFAYETTE ST SUITE A
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City | SHELBY
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State | NC
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Zip | 28150-3978
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Country | US
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Telephone | 704-301-8093
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Fax | 704-301-8093
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Provider Business Mailing Address
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Address Line | 449 PAUL H. BEAM ROAD
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City | CHERRYVILLE
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State | NC
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Zip | 28021
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Country | US
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Telephone | 704-301-8093
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Fax | 704-301-8093
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3813
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License Number State | NC
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