Provider Demographics
NPI:1174163166
Name:BENNETT-PRETTENHOFER, JOHANNA (LCAS,CCS, CCTP)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:BENNETT-PRETTENHOFER
Suffix:
Gender:F
Credentials:LCAS,CCS, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CLIFFRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-9424
Mailing Address - Country:US
Mailing Address - Phone:704-989-0391
Mailing Address - Fax:
Practice Address - Street 1:100 CLIFFRIDGE RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-9424
Practice Address - Country:US
Practice Address - Phone:980-352-0635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22110101YA0400X
NC16411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)