Provider Demographics
NPI:1336693803
Name:BENTON, NZINGA (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:NZINGA
Middle Name:
Last Name:BENTON
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5679 GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6214
Mailing Address - Country:US
Mailing Address - Phone:678-471-6208
Mailing Address - Fax:
Practice Address - Street 1:5679 GEORGE RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-6214
Practice Address - Country:US
Practice Address - Phone:404-981-1341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009107101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional