Provider Demographics
NPI:1902358328
Name:MALONE, BENNETTI G (MSED, LPC, LICDC)
Entity Type:Individual
Prefix:
First Name:BENNETTI
Middle Name:G
Last Name:MALONE
Suffix:
Gender:F
Credentials:MSED, LPC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91347
Mailing Address - Street 2:
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-7347
Mailing Address - Country:US
Mailing Address - Phone:614-235-6795
Mailing Address - Fax:
Practice Address - Street 1:1289 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2838
Practice Address - Country:US
Practice Address - Phone:614-252-8834
Practice Address - Fax:614-252-0158
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161395101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)