Provider Demographics
NPI:1053701219
Name:BENNEFIELD, MONICA ELAINE (LCSW)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:ELAINE
Last Name:BENNEFIELD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 CCA WAY
Mailing Address - Street 2:
Mailing Address - City:LUMPKIN
Mailing Address - State:GA
Mailing Address - Zip Code:31815
Mailing Address - Country:US
Mailing Address - Phone:229-838-1275
Mailing Address - Fax:229-838-1242
Practice Address - Street 1:146 CCA WAY
Practice Address - Street 2:
Practice Address - City:LUMPKIN
Practice Address - State:GA
Practice Address - Zip Code:31815
Practice Address - Country:US
Practice Address - Phone:229-838-1275
Practice Address - Fax:229-838-1242
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0042171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical