Provider Demographics
NPI:1619749868
Name:BENNETT, PATRICE (EDD, LAPC)
Entity Type:Individual
Prefix:DR
First Name:PATRICE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:EDD, LAPC
Other - Prefix:
Other - First Name:PATRICE
Other - Middle Name:
Other - Last Name:CODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-1320
Mailing Address - Country:US
Mailing Address - Phone:678-276-9894
Mailing Address - Fax:
Practice Address - Street 1:333 ALCOVY ST STE A-3
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2180
Practice Address - Country:US
Practice Address - Phone:678-276-9894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014559101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional