Provider Demographics
NPI:1790285120
Name:SUSTAINING HOPE AND WELLNESS, LLC
Entity Type:Organization
Organization Name:SUSTAINING HOPE AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENZAN-MONTEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW & LICSW
Authorized Official - Phone:617-600-8720
Mailing Address - Street 1:PO BOX 2096
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-2096
Mailing Address - Country:US
Mailing Address - Phone:617-600-8720
Mailing Address - Fax:
Practice Address - Street 1:125 E TRINITY PL STE 314
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3360
Practice Address - Country:US
Practice Address - Phone:617-600-8720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
GACSW0058801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty