Provider Demographics
NPI:1639238553
Name:BENGELS, ROBERT WORTHINGTON (LPC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WORTHINGTON
Last Name:BENGELS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 282K
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503-9409
Mailing Address - Country:US
Mailing Address - Phone:912-816-0436
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 282K
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31503-9409
Practice Address - Country:US
Practice Address - Phone:912-816-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003397101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health