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General NPI Number Information
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NPI Number | 1942703806
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Entity Type | Individual
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Provider Name | KATINA LYNN BENNETT LLPC
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Gender | Female
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 03/16/2018
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Provider Practice Location Address
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Address Line | 54710 BATES RD
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City | CHESTERFIELD
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State | MI
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Zip | 48051-1621
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Country | US
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Telephone | 586-219-2791
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Fax |
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Provider Business Mailing Address
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Address Line | 54710 BATES RD
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City | CHESTERFIELD
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State | MI
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Zip | 48051-1621
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Country | US
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Telephone | 586-219-2791
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401016114
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License Number State | MI
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