Provider Demographics
NPI:1982002754
Name:BENNETT, JANETH LEIGH (LPC)
Entity Type:Individual
Prefix:
First Name:JANETH
Middle Name:LEIGH
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 HUNTERS DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-4081
Mailing Address - Country:US
Mailing Address - Phone:912-574-7522
Mailing Address - Fax:912-574-7521
Practice Address - Street 1:2060 DAN PROCTOR DR
Practice Address - Street 2:SUITE 3300
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3894
Practice Address - Country:US
Practice Address - Phone:912-882-3800
Practice Address - Fax:912-882-3303
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005923101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional