Provider Demographics
NPI:1174955009
Name:BENNETT, CONSTANCE LORAINE (MS,LPCC)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:LORAINE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS,LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 34TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3831
Mailing Address - Country:US
Mailing Address - Phone:612-554-9661
Mailing Address - Fax:612-645-5970
Practice Address - Street 1:4318 34TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406
Practice Address - Country:US
Practice Address - Phone:612-554-9661
Practice Address - Fax:612-328-9555
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00607101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional