Provider Demographics
NPI:1013579309
Name:ROBINSON, SHANEL BENZINA (MS, LPC, NCC, CCMHC)
Entity Type:Individual
Prefix:
First Name:SHANEL
Middle Name:BENZINA
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MS, LPC, NCC, CCMHC
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 725003
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31139-2003
Mailing Address - Country:US
Mailing Address - Phone:404-590-6977
Mailing Address - Fax:
Practice Address - Street 1:848 HIRAM ACWORTH HWY BLDG 100
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2286
Practice Address - Country:US
Practice Address - Phone:404-334-7575
Practice Address - Fax:404-334-7599
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011324101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health