Provider Demographics
NPI:1174957997
Name:BENNETT, LYDIA BACKER (LPC)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:BACKER
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16708
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28816-0708
Mailing Address - Country:US
Mailing Address - Phone:828-254-5356
Mailing Address - Fax:828-259-5384
Practice Address - Street 1:2 COMPTON DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2054
Practice Address - Country:US
Practice Address - Phone:828-254-5356
Practice Address - Fax:828-259-5384
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8759101YM0800X
NC10520101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health