Provider Demographics
NPI:1164688537
Name:NEAL, BENJAMIN E (LPC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:E
Last Name:NEAL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CHURCHILL CT
Mailing Address - Street 2:700
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6331
Mailing Address - Country:US
Mailing Address - Phone:678-231-2031
Mailing Address - Fax:
Practice Address - Street 1:250 CHURCHILL CT
Practice Address - Street 2:700
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6331
Practice Address - Country:US
Practice Address - Phone:678-231-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004155101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional