Provider Demographics
NPI:1235688250
Name:SERVE, LLC
Entity Type:Organization
Organization Name:SERVE, LLC
Other - Org Name:DBA: ANNETTE J BENNECHE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNECHE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-332-7503
Mailing Address - Street 1:110 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-1108
Mailing Address - Country:US
Mailing Address - Phone:706-453-7400
Mailing Address - Fax:855-898-5414
Practice Address - Street 1:110 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2720
Practice Address - Country:US
Practice Address - Phone:912-332-7503
Practice Address - Fax:855-898-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10241OtherRISK REDUCTION PROGRAM
GA003129023AMedicaid
GA003129023BMedicaid
GA6546980314546176OtherGEORGIA COMMISSION ON FAMILY VIOLENCE