Provider Demographics
NPI:1760227227
Name:BENFORD, JENNIFER (LCSW)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:BENFORD
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 1:132 GOBER DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30530-4384
Mailing Address - Country:US
Mailing Address - Phone:770-713-9897
Mailing Address - Fax:
Practice Address - Street 1:132 GOBER DR
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30530-4384
Practice Address - Country:US
Practice Address - Phone:770-713-9897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW006617101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health