Basic Information
| Provider Information | |||||||||
| NPI: | 1053701219 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENNEFIELD | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 146 CCA WAY | ||||||||
| Address2: | |||||||||
| City: | LUMPKIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2298381275 | ||||||||
| FaxNumber: | 2298381242 | ||||||||
| Practice Location | |||||||||
| Address1: | 146 CCA WAY | ||||||||
| Address2: | |||||||||
| City: | LUMPKIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2298381275 | ||||||||
| FaxNumber: | 2298381242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2015 | ||||||||
| LastUpdateDate: | 01/27/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW004217 | GA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.