Provider Demographics
NPI:1003617051
Name:BENTLEY, LIKEBA I (LMSW)
Entity type:Individual
Prefix:
First Name:LIKEBA
Middle Name:I
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 BLACKMON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39272-6002
Mailing Address - Country:US
Mailing Address - Phone:601-383-7328
Mailing Address - Fax:
Practice Address - Street 1:155 BLACKMON RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39272-6002
Practice Address - Country:US
Practice Address - Phone:601-383-7328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM11403104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker