Provider Demographics
NPI:1598460768
Name:BENNETT, TREBLA COLE (LPC)
Entity Type:Individual
Prefix:
First Name:TREBLA
Middle Name:COLE
Last Name:BENNETT
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 1:613 WINIFRED RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-5342
Mailing Address - Country:US
Mailing Address - Phone:662-364-2066
Mailing Address - Fax:
Practice Address - Street 1:613 WINIFRED RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-5342
Practice Address - Country:US
Practice Address - Phone:662-364-2066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013596101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor