Provider Demographics
NPI:1245659176
Name:BENNINK, JOY ELIZABETH (LMHC, CAP, ATR)
Entity type:Individual
Prefix:MS
First Name:JOY
Middle Name:ELIZABETH
Last Name:BENNINK
Suffix:
Gender:F
Credentials:LMHC, CAP, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 PARKBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-8917
Mailing Address - Country:US
Mailing Address - Phone:850-933-9387
Mailing Address - Fax:
Practice Address - Street 1:742 SW GREENVILLE HILLS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:FL
Practice Address - Zip Code:32331-3107
Practice Address - Country:US
Practice Address - Phone:850-948-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 5476101YA0400X
FLMH8585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767447300Medicaid