Provider Demographics
NPI:1144657420
Name:BENEFIELD, DEANN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:DEANN
Middle Name:
Last Name:BENEFIELD
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 1:334 TIFTON ELDORADO RD
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-9497
Mailing Address - Country:US
Mailing Address - Phone:229-391-2300
Mailing Address - Fax:229-671-6774
Practice Address - Street 1:3120 N OAK STREET EXT STE C
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-5910
Practice Address - Country:US
Practice Address - Phone:229-671-6100
Practice Address - Fax:229-671-6774
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005949104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA005949OtherLICENSE NUMBER