Provider Demographics
NPI:1992372429
Name:BENSON, EARNEST TERENCE (LPC)
Entity Type:Individual
Prefix:MR
First Name:EARNEST
Middle Name:TERENCE
Last Name:BENSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:ERNEST
Other - Middle Name:
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:4644 POWDER SPRINGS DALLAS RD UNIT 1242
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-7710
Mailing Address - Country:US
Mailing Address - Phone:678-336-5535
Mailing Address - Fax:
Practice Address - Street 1:240 MEADOW CREST WAY
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-5772
Practice Address - Country:US
Practice Address - Phone:678-336-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012175101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional