Provider Demographics
NPI:1467898171
Name:BENENATI, JESSICA R (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:R
Last Name:BENENATI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3482 KEITH BRIDGE RD # 261
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5546
Mailing Address - Country:US
Mailing Address - Phone:678-592-0817
Mailing Address - Fax:
Practice Address - Street 1:5415 OLD HAVEN CT
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5539
Practice Address - Country:US
Practice Address - Phone:678-592-0817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007701101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health