Provider Demographics
NPI:1902462922
Name:BENNETT, CALANDRA J
Entity Type:Individual
Prefix:
First Name:CALANDRA
Middle Name:J
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CALANDRA
Other - Middle Name:J
Other - Last Name:BLOCKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5950 CROOKED CREEK RD STE 170K
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2406
Mailing Address - Country:US
Mailing Address - Phone:740-561-3041
Mailing Address - Fax:
Practice Address - Street 1:5950 CROOKED CREEK RD STE 170K
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-2406
Practice Address - Country:US
Practice Address - Phone:740-561-3041
Practice Address - Fax:888-505-6039
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPC010937101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health