Provider Demographics
NPI:1134878622
Name:BENSON, DE'ANNA (LMSW)
Entity type:Individual
Prefix:
First Name:DE'ANNA
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 DEANNA CIR APT 3I
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:42262-9392
Mailing Address - Country:US
Mailing Address - Phone:463-999-6736
Mailing Address - Fax:
Practice Address - Street 1:1989 MADISON ST STE 222
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5067
Practice Address - Country:US
Practice Address - Phone:931-266-6954
Practice Address - Fax:866-371-4056
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2566301041C0700X
TN132241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical