Provider Demographics
NPI:1356845937
Name:D. BENNETT COUNSELING AND CONSULTING SERVICES LLC
Entity Type:Organization
Organization Name:D. BENNETT COUNSELING AND CONSULTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:404-441-1019
Mailing Address - Street 1:614 VALLEY BROOK RD # 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:404-441-1019
Mailing Address - Fax:
Practice Address - Street 1:614 VALLEY BROOK RD # 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:404-441-1019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009976251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health