Provider Demographics
NPI:1396458626
Name:CAMPBELL-BENITEZ, SARAH GABRIELLE (MA, LPC-MHSP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:GABRIELLE
Last Name:CAMPBELL-BENITEZ
Suffix:
Gender:F
Credentials:MA, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 BRADLEY DR APT 1
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1444
Mailing Address - Country:US
Mailing Address - Phone:931-743-9105
Mailing Address - Fax:
Practice Address - Street 1:570 E 10TH ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1876
Practice Address - Country:US
Practice Address - Phone:931-372-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health