Provider Demographics
NPI:1235632860
Name:BENNETT, DEL MARSHA (EDD)
Entity Type:Individual
Prefix:DR
First Name:DEL
Middle Name:MARSHA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 VALLEY BROOK RD STE 120
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6022
Mailing Address - Country:US
Mailing Address - Phone:404-299-5580
Mailing Address - Fax:
Practice Address - Street 1:614 VALLEY BROOK RD STE 120
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6022
Practice Address - Country:US
Practice Address - Phone:404-299-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health