Provider Demographics
NPI:1477854040
Name:ESPOSITO, BENITA A (LPC, LCMHC)
Entity type:Individual
Prefix:
First Name:BENITA
Middle Name:A
Last Name:ESPOSITO
Suffix:
Gender:F
Credentials:LPC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1074
Mailing Address - Street 2:
Mailing Address - City:YOUNG HARRIS
Mailing Address - State:GA
Mailing Address - Zip Code:30582-1074
Mailing Address - Country:US
Mailing Address - Phone:770-998-6642
Mailing Address - Fax:
Practice Address - Street 1:168 ROGERS ST STE 206
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3693
Practice Address - Country:US
Practice Address - Phone:770-998-6642
Practice Address - Fax:706-896-0031
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15664101YP2500X
GA000300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty